Thank you for your interest in partnering with us to improve our services.
Patient & Family Advisory Committee (PFAC) Form
Interested in joining? Please complete the form below.
How long have you or your family member been a patient at Saban Community Clinic?
What Clinic Location do you or your family member go to?
What services have you or your family member received? (Choose all that apply)
Times (choose all that apply)
Days of the Week (choose all that apply)
Would you be able to serve on this committee for a year-long term? (Your commitment availability will not affect your consideration for this committee)
If committee meetings are held virtually, will you need internet and video conferencing access?