Patient Partnerships

Help a child. Donate.

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Name of doctor who referred you

Department you are being referred to (if known)

Attach a referral*

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Please make sure that your attachment is clear and legible. We do not process incomplete applications or provide appointments without a copy of the referral. If you do not attach your referral, you will need to fax it to the department directly. Wait times depend on the priority assigned to the referral and can be as long as several months.

Patient Information

Child's last name*

Child's first name*

Date of birth*

MCH Medical record number (if known)

Health insurance card number*

Health insurance card expiration date*

'DD' corresponds to the child's date of birth.

Address*

Select your province or territory*

City*

Postal code*

Contact Information (for parent or guardian)

Your first name*

Your last name*

Your relationship to patient*

Email address

Phone number*

Alternate phone number

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Patient Partnerships

What is a family partner?
Who can become a family partner?
What is the time commitment?

We believe in partnering with patients and families to provide the best care possible. We would like to hear from you on what you think we are doing well and where you feel we can improve. Together, we can work to develop ways to make the patient and family experience better at the MCH.

What is a family partner?

A family partner is a family member of a child who has received care at the Montreal Children’s Hospital. Family partners provide an important and unique perspective and work with staff to influence the hospital’s policies, programs and practices. They can:

Share a story during staff meetings, staff orientation and educational sessions.
Participate in working groups, committees or projects.
Create and review patient education material.
Collect and analyze patient experience data.
Give presentations in meetings and/or at conferences.
Co-design and co-instruct training sessions and workshops.
Engage in the development and implementation of research.

Who can become a family partner?

You can become a family partner if you are a family member of a child who has received care at the Montreal Children’s Hospital within the past five years AND:

Have a passion for improving the experience of patients and families.
Are comfortable speaking in a group and sharing with others.
Are open to other peoples’ perspectives and ideas.
Agree to respect privacy and confidentiality agreements.

What is the time commitment?

There is no set amount of time required. Family partners usually volunteer one to four hours per month. The time commitment is flexible and we match your volunteer schedule to your availability.

Patient Partnerships

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone number(Required)

Languages spoken(Required)

French

English

Other

Availabilites(Required)

Weekdays (you are available occasionally between 9:00 a.m. and 5:00 p.m. Monday to Friday)

Evenings (you are available occasionally between 6:00 p.m. to 9:00 p.m. Monday to Friday)

Other

When did your child last receive care at the MCH?(Required)

In which main unit/department of the hospital did your child receive care?(Required)

Why are you interested in becoming a family partner?(Required)

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