Text size
Home / About/ Patient Council/ Patient Partner Application Form

Patient Partner Application Form

Patient Partner Application Form

Thank you for your interest to join Sepsis Canada as a Patient Partner. As a Patient Partner your insights and lived experience will help us conduct research that is relevant and of importance to sepsis patients and their families. Please complete this form to be considered as a candidate for a Patient Partner position.

*indicates required fields.

Thank you for your interest to join Sepsis Canada as a Patient Partner. As a Patient Partner your insights and lived experience will help us conduct research that is relevant and of importance to sepsis patients and their families. Please complete this form to be considered as a candidate for a Patient Partner position.

This section will help us to get to know you and your story better.

Please select a time(s) of day you are available to participate in Patient Partner activities (e.g., meetings). Please check all that apply.
There are many ways to participate as a Patient Partner. Please check the potential roles/responsibilities that are of interest to you.
There are many areas that Sepsis Canada conducts research within. Please check the research areas that are of interest to you: