Information on the Patient Advisory Council
Felix Health Inc. (the “Company”) is accepting applications to join its Patient Advisory Council (PAC), a group of patients who share their perspectives and experiences to help the Company improve its services, programs, and communications. This page explains what joining the PAC involves, how your information will be used, and the choices available to you. Please read it carefully before signing.
Before you sign, you may ask questions about anything in this form by contacting [email protected]. Your application to the PAC is voluntary, and you may withdraw at any time as described below.
Purpose of Collection
The Company collects your personal information as part of the PAC application and membership process in order to:
- Assess your eligibility and fit for the PAC based on your experience with Felix Health
- Understand the perspectives and lived experience you bring to the Council, and
- If selected, coordinate your participation in PAC meetings, discussions, and activities
Information collected may include your name, contact information, and details you choose to share about your experience as a patient, including relevant health-related context you provide voluntarily as part of your application or participation.
The application may also include optional demographic fields (for example, age range, location, etc). These fields help the Company build a PAC that reflects a range of patient experiences. Completing these fields is optional, and you may leave them blank without affecting your application.
Application Review and Notification
Applications are reviewed by the Company’s PAC selection team against factors such as fit with current PAC needs, diversity of patient experience represented, and availability. The Company will notify you of the outcome of your application up to two years after your application has been submitted. If your application is not approved, you may still be asked whether the Company can retain your information to consider you for future PAC openings.
How and Where Your Information May Be Used, Disclosed, or Retained
Information collected through this form will be used by the Company to operate and administer the PAC, including reviewing applications, coordinating meetings, and maintaining internal records of membership and participation.
Your information will not be shared outside the Company for marketing or promotional purposes as part of this consent. Information may be stored in the Company’s internal systems and shared internally on a need-to-know basis with the team(s) responsible for administering the PAC (for example, Patient Engagement and/or Compliance staff).
How Your Information is Protected
The Company takes reasonable administrative, technical, and physical safeguards to protect your information against unauthorized access, use, disclosure, alteration, or destruction. These safeguards include restricting access to your information to personnel who require it to administer the PAC, and storing records in systems consistent with the Company’s privacy and information security policies.
Who Is Involved
The following parties may be involved in the collection, use, disclosure, and retention of your information in connection with the PAC:
- Felix Health Inc., including staff responsible for patient engagement, compliance, and PAC administration;
How and When Your Information Will Be Destroyed
The Company will retain your information in accordance with the following minimum retention periods:
- Applicants who join the PAC: a minimum of 2 years from the end of your membership term.
- Applicants who do not join the PAC (e.g., your application is declined or withdrawn): a minimum of 2 years from the date of submission.
The Company may retain your information for longer than these minimum periods where required by law or necessary to resolve a dispute. After the applicable retention period, your information will be securely destroyed or de-identified in accordance with the Company’s data retention and destruction policies.
Potential Benefits and Risks of Consenting
Potential benefits of applying may include the opportunity to influence how Felix Health services are designed and delivered, to connect with other patients, to have your experience considered in decisions that may affect future patients.
Risks of applying to the PAC may include (non-exhaustive):
- By applying to the PAC, you are bound by the respective privacy policies and community guidelines of any third party platform used to conduct PAC applications (i.e. Google)
Withdrawal Process
Your application to join the PAC is entirely voluntary. You may decline to answer questions or withdraw your application entirely at any time, without consequence to your care or your ability to use the Felix Health platform.
To withdraw your consent or your PAC application, contact [email protected].
Waiver and Release
I confirm that I unconditionally consent to the Company (which in this Section includes all of its officers, directors, successors, employees and agents) to use and share information I provide as part of my PAC application (including my name, contact information, and any feedback, experiences, or perspectives I share) for the purpose of administering the PAC, as described in this consent form.
I have had the purpose and nature of the PAC explained to me in writing, and I have had the opportunity to ask questions. I hereby realize and accept that I am participating on a voluntary basis and will not receive financial compensation from the Company for my application or participation, unless otherwise agreed in writing. I agree to indemnify and hold harmless the Company, its affiliates, directors, officers, employees, agents, successors, and assigns from and against any and all claims, demands, liabilities, losses, and expenses arising out of or related to (i) any breach of representation or warranty made in this acknowledgement, (ii) any inaccuracy in the statements or information I provide as part of my PAC application or participation, or (iii) any other claim arising out of my participation in the PAC.
I have been informed of the risks of participating in the PAC, as described in this form. I confirm that any information I share as part of the PAC is not intended to constitute individual medical advice, and does not identify a specific clinician, prescription drug, or treatment protocol prescribed to me by a physician or nurse practitioner. I have been informed that I may withdraw my consent at any time via email by contacting [email protected].
By submitting my application, I warrant that I have the capacity and right to grant the permission requested in this document and that I provide the Company with that permission. I have read, understand, and agree to all of the above.