Be a Patient Ambassador

 

Create awareness while having fun.

Dr. Martin with patientConnecticut Children’s Medical Center Foundation invites patients to serve as Patient Ambassadors and represent Connecticut Children’s in the community.

Patients, their siblings and their caregivers are invited to participate in a variety of fun activities throughout the year, including baseball games, dance marathons, road races, car shows, and more, at no cost to patient families. In addition, caregivers are invited to share stories of their experiences at Connecticut Children’s, if that is of interest.

To learn more about becoming a Patient Ambassador, complete and submit the form below. A Connecticut Children’s Medical Center Foundation representative will contact you in the days ahead.

We won’t publish any stories without permission, so please be sure to provide current contact information so that we may follow up.


Patient Information

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Question - Required - Patient's Date of Birth:




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Guardian Contact Information

If patient is under 18 years old, please use the following fields for parent/guardian information. If patient is 18 or older, please use the following fields for patient’s contact information.


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  Guardian information:

 

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Question - Required - I would like to share our family's Connecticut Children's story.


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