Get Involved – Équipe Santé Ontario Cochrane District Ontario Health Team

Transforming Regional Health Care

Join us in shaping the future of health care in the Cochrane District. By partnering with the Équipe Santé Cochrane District Ontario Health Team, you’ll collaborate to create a more integrated, accessible, and patient-centered system. Whether as a community advocate, healthcare provider, or organizational partner, your involvement will help improve health outcomes and enhance our community’s well-being. Together, we can make a meaningful impact.

Community Partnership

Get involved as a community partner, by completing the following steps.

Complete the expression of interest form.
Join the patient family and caregiver council.
Once joined, you will gain access to all council, committee, and working group updates.

Join us in shaping the future of health care in the Cochrane District.

Apply Now

Organization Partnership

Get involved as an organization partner, by completing the following steps.

Complete the partnership application form.
Join the ÉSOCDOHT's Collaboration Council.
A team member will be in touch regarding the status of your application.

Join us in shaping the future of health care in the Cochrane District.

Apply Now

Clinician Partnership

Get involved as a clinician partner, by completing the following steps.

Complete the partnership application form.
Join the Cochrane District's Primary Care Network.
A team member will be in touch regarding the status of your application.

Join us in shaping the future of health care in the Cochrane District.

Apply Now

Community Partnership

Thank you for your interest in becoming a member of the Patient, Family and Caregiver Council (PFACC) of the Équipe Santé Ontario Cochrane District Ontario Health Team (ÉSOCDOHT).

Please fill out the following application, to the best of your ability. If you have any questions or concerns, or prefer to share this information with the ÉSOCDOHT in a different format, please reach out to info@esocdoht.ca.

Personal Information

First Name

Last Name

Email Address

Phone Number

Mailing Address

What is the best way to contact you?

Preferred Contact Method

Email Phone

When is the best time to contact you?

Preferred Contact Time

Morning Afternoon Evening Weekday Weekend

If it is beneficial, how might we offer you accommodations for communication with you?

Communication Accommodations

Demographics

I identify as:

Identification

Patient or client Family member of a patient or client Caregiver of a patient or client

Gender:

Gender

Man Woman Transgender Man Transgender Woman Non-Binary Prefer not to say Other

Age Range:

Age Range

10-17 18-24 25-34 35-44 45-54 55-64 65+ Prefer not to say

Ethnicity or Cultural Origin:

Ethnicity or Cultural Origin

Indigenous (First Nation, Métis, Inuit) White/European Black (African, Afro-Caribbean, African-Canadian, etc.) Latino/Latinx (Latin America, Hispanic, etc.) East Asian (Chinese, Korean, Japanese, Taiwanese, etc.) Middle Eastern (Arab, Persian, West Asian, etc.) South Asian (East Indian, Pakistani, Sri Lankan, Indo-Caribbean, etc.) Southeast Asian (Filipino, Vietnamese, Cambodian, Thai, etc.) Prefer not to say Other

I also identify as part of the following:

I also identify as part of the following

Being part of the 2SLGBTQ+ community Being francophone Having a disability Having a low-income Prefer not to say None apply to me Other

Education Level:

Education Level

Less than High School High School College Technical certification University Post-Graduate Other

Your Experiences

What interests you in becoming a part of the ÉSOCDOHT Patient & Family Advisory Council?

Interest in Joining

What are some of the specific things that health and social services are doing well in our district?

Positive Review

What are some of the specific things that you would like to see the health and social services do better in our district?

Improvements

Do you have any special interests in regards to health and social services?

Special Interests

Which services do you (or your family/the person you care for) have experience accessing?

System Experience

Family Doctor or Nurse Practitioner Geriatric Services Community Care Emergency Department Long-Term Care Home Care Social Services Mental Health & Addiction Services

Do you have previous experience being an advisor in the healthcare or social services settings?

Previous Experience

Yes No

How did you hear about this opportunity?

Reference

Healthcare Setting Marketing Materials (Pamphlet, Flyer, Ad) Social Media Website News Radio Other

Your Involvement Preferences

What is your availability for meetings and participation (daytime, evenings, weekends, etc.)? Please describe any perceived barriers to your participation.

Availability

How would you like to be involved in the council?

Involvement

Is there anything else about yourself that you would like to share with us?

Additional Comments

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Acknowledgment

All information contained in your submitted application is confidential and is only intended for use by the ÉSO Cochrane District OHT Steering Committee members for the selection of members of the PFAC.

Acknowledgment

By submitting an application, I agree to give the ÉSOCDOHT permission to talk about my application in the selection process. I consent to a member of the ÉSOCDOHT reaching out to me to participate in an interview as part of the selection process. I understand that I am not guaranteed an advisory role on the ÉSOCDOHT PFACC. I understand that I may withdraw my application at any time.

Organization Partnership

To become an organization partner with the Équipe Santé Ontario Cochrane District Ontario Health Team, please complete the partnership application form below. This is your first step in joining us to shape the future of health care in our region.

Once you’ve submitted the form, a team member will contact you regarding the status of your application. By joining the ÉSOCDOHT, you’ll play a key role in improving health care and making a meaningful impact in our community.

Organization Information

Organization Name

----------

Primary Representative

First Name

Last Name

Title

Email Address

Phone Number

Mailing Address

----------

Administrative Staff

First Name

Last Name

Title

Email Address

Phone Number

Mailing Address

----------

Key Questions

What is your affiliation with other Ontario Health Teams?

Ontario Health Team Affiliation

What inspired you to explore a partnership with the Cochrane District Ontario Health Team?

Inspiration

Which network does your organization represent?

Networks

Long Term Care/Retirement Acute Care Children’s Services Education Home Community Care Support Services Mental Health & Addictions Indigenous (First Nation, Metis, Inuit) Social Services Other

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Acknowledgment

Thank you for your interest in contributing to health care and social services planning in our district. We will notify all applicants about their application status. The information provided is confidential and will be used solely for the partnership. You may be contacted for an interview, and all applications will be kept on file.

Clinician Partnership

To become a clinician partner with the Équipe Santé Ontario Cochrane District Ontario Health Team, please complete the partnership application form below. This is your first step in joining us to shape the future of health care in our region.

Organization Information

Organization Name

----------

Primary Representative

First Name

Last Name

Title

Email Address

Phone Number

Mailing Address

----------

Administrative Staff

First Name

Last Name

Title

Email Address

Phone Number

Mailing Address

----------

Key Questions

What is your affiliation with other Ontario Health Teams?

Ontario Health Team Affiliation

What inspired you to explore a partnership with the Cochrane District Ontario Health Team?

Inspiration

Which network does your organization represent?

Networks

Long Term Care/Retirement Acute Care Children’s Services Education Home Community Care Support Services Mental Health & Addictions Indigenous (First Nation, Metis, Inuit) Social Services Other

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