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Virtual Advisory Council Application

Share your voice! Listening to the voices of those we care for is critical to delivering an exceptional experience at Community Health Network. The Virtual Advisory Council is a group of people who volunteer to provide opinions via email on a variety of topics. Virtual Advisory Council members will receive a short survey requesting feedback and thoughts on specific topics no more than three times per month. This feedback will help guide our decisions regarding care and services at Community Health Network.

For questions about the application process, please call 317-621-7001 or email PatientExperience@eCommunity.com.


Name
Address
Gender
Are you a patient or the family/friend of a patient?
Where have you or your loved one received care? Check all that apply.
I wish to receive other email communications from Community Health Network:

Optional Demographic Survey

We’d like to know more about our Community Advisory Council members. Please take a couple of minutes to fill out the information below. Select "Yes" to view the questions.

I would like to participate in the demographic survey:
Are you or have you ever been an employee of Community Health Network?
What is your age?
What is the highest grade or level of school that you have completed?
What is your race? Mark one or more.
What is your marital status?
How many children under the age of 18 live in your household?
What is your combined household income?
What is your current employment status?