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Family Advisory Board Membership Application

Application Information

Do you have improvements or ideas you would want to bring to Children's Mercy?

What are the names of your children who were cared for at Children's Mercy? What clinics, units, and/or physicians did they receive care from?

May we contact the clinics, units, and/or physicians who have cared for your child or children?

Please note that the information you enter into this form will be held in the strictest of confidence and will not be used or disseminated for any purpose other than as a tool to determine membership eligibility.

If selected as a member of the Family Advisory Board (FAB), I understand that communication between members is essential. Given this, I understand my name, address, phone number and email address will be provided to all FAB members.