Required fields are marked with an asterisk *. Medical City Arlington Patient Advisory Board ApplicationFull Name *AddressWhat is your preferred way of receiving communication about the Board? E-mail Regular Mail TelephoneHave you or a family member received care at Medical City Arlington? Yes NoIf yes, when was the care provided?Why would you like to be on the Board?What issues would you like to see the Board address?What special interest, expertise or experiences would you like to offer to the Board?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. Rate Your Experience Submit SuccessThe form was successfully sent. There was an error with the form submission.