Patient Partner Council Membership Application

  • Thank you for your interest in this volunteer opportunity to participate as a member of the Patient Partner Council at Listowel Wingham Hospitals Alliance. Please complete and submit this form. Refer to the volunteer posting for more information about the council. After submission of this form, you will be contacted via email for next steps.

  • Applicants who are selected for an interview will be contacted within 30 days of submission of the application form.

    Personal information contained on this form is collected pursuant to the Public Hospitals Act and the Freedom of Information and Protection of Privacy Act (FIPPA), and will be used for the purpose of Patient Partner Council selection and placement at LWHA. We will not share this information otherwise without permission from the applicant / guardian.

  • This field is for validation purposes and should be left unchanged.
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