Required fields are marked with an asterisk *.

Medical City Arlington Patient Advisory Board Application

What is your preferred way of receiving communication about the Board?
Have you or a family member received care at Medical City Arlington?

The completion of this application does not bind the applicant or the hospital in any way. The Patient and Family Advisory Board reserves the right to choose participants that best meet the needs of the program. If selected to participate on the Board, you will be asked to sign a confidentiality agreement. Please call (682) 509-6033 if you have questions.

Success

The form was successfully sent.

There was an error with the form submission.