Care Hero Form
Your Information:
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Name of Hospital Team Member (Care Hero)
Tell us about your experience:
Please describe your experience, what made the care stand out to you?
What message would you like shared with your Care Hero?
Would you be willing to allow the Foundation to share your story with other donors and for use in our impact reports?
Yes
No
Would you like us to pass along your feedback to the Patient Experience team at Grand River Hospital?
Yes
No
Thank you for sharing with us!
Submit your feedback
Should be Empty: