Lgo
New User Details
Please create your desired User ID and Password above.
(User ID must be a valid email)
For help contact:
Essentia Health East Volunteer Services 407 East Third Street Duluth, MN 55805 (218)786-4420
Essentia Health
Patient Partners/Advisory Council Application
Become a Patient Partner
Is this right for me? Patient Partners are people from all walks of life who have experienced care at Essentia Health.
You can make a difference. Help shape the way healthcare is experienced. Just answer a few questions and submit this form. We'll be in touch soon.
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Personal Information
Emergency Contact
___________________________________________________________________________________________________________________
Essentia Health Confidentiality Agreement
______________________________________________________________________________________________
I hereby authorize investigation of all statements contained in this application. I further authorize my reference permission to furnish Essentia Health East with facts and opinions as to my job performance, capabilities and desirability as a volunteer. I further release all persons whomsoever from any damage because of furnishing said information.
Volunteer opportunities are provided without regard to religion, creed, race, national origin, sexual orientation, age, gender, disability, marital status or status with regard to public assistance. Essentia Health East does not imply that you will be assigned a volunteer position and this application should not be construed as a contract or promise of a volunteer position.
Patient Partners/Advisory Council Form 2017