Privacy and Confidentiality Form

Please check the box below:*
- I provide consent for the BC Patient Safety & Quality Council to share my responses to an engagement invitation with the health care partner leading the engagement. I also consent to my name and email address being shared with other selected volunteers participating in the same opportunity.
Please choose your region in BC:*
- Fraser Valley & Lower Mainland Region
- Interior Region
- Northern Region
- Vancouver Island Region
I understand compliance with this Agreement is a condition of participating in the mentorship program with the Patient Voices Network and that failure to comply may result in a discontinuation of my involvement and follow-up by BCPSQC.
To sign the Privacy, Safety & Confidentiality Agreement, please fill out your full name below:*
Email*
Date:*
MM slash DD slash YYYY

From Our Community

Christine Wallsworth

Patient Partner, Vancouver

Patient and family partners should not be a check box on research proposals! They need to be involved right from the start. I know patient and family partners are doing their part by providing their knowledge to researchers from their lived experience. It’s a win-win for us to work together through PVN to make sure our input drives improvements.