Patient Comfort & Kindness Impact Survey

Name:(Required)

First Last

Email:(Required)

Phone:

Department:(Required)

Campus:

Amount Received:(Required)

Describe how you have made use of the funds to date:(Required)

Describe the impact this grant has had on lives of the patients and/or clients you serve:(Required)

Please provide any patient testimonials, stories or photos:

Photos

Accepted file types: jpg, jpeg, png, Max. file size: 10 MB.

Do you have any feedback in regards to the application process?