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Schedule a Meeting or Speaking Engagement

Office of the Patient Advocate (OPA) staff are available to speak about patients rights at events such as health care provider meetings, community forums, patient support groups, places of worship, local community centers, senior centers, union meetings, employee meetings etc. Presentations are available in various languages through interpreters and sign language.

Fill out the following form to request a speaking engagement or meeting with an OPA staff.

If you wish to schedule OPA staff to participate in your community event, please indicate under type of request on the form below.

* Indicates A Required Field

1. Event Information:

Name or Group Requesting:*

Type of Request:*

Date of Event:*

Time of Event:*

Location of Event:*

Expected Number of People in Attendance:*

Additional Information:*

2. Contact Information

Name:*

Address:*

City:*

State:*

Zip Code:*
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Phone Number:*
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E-mail Address:*