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What's your story? We'd love to hear it!
◊ Have you found your Dr. Right? 
◊ Have you faced a medical challenge?

If you would like to share your story with others, please use this form to contact us. We'd love to hear the story of the care you received at PeaceHealth Medical Group.

Do you have a compelling story about your doctor? 
Please share your story with us and it could go on the YOU 101 Blog. 

(Please Note: It is possible that unsecure (unencrypted) email could be intercepted and read by third parties. For this reason, we ask that you do not send any personal and/or confidential information.)
* Indicates required information
My full    
name: * 
 
 
TELL US ABOUT THE CARE YOU RECEIVED
  
Procedure/ treatment: 
How this affected my life: 
What I think others should know: 
 
 
TELL US A LITTLE ABOUT YOURSELF
  
 
 
TELL US ABOUT THE PEOPLE WHO CARED FOR YOU
AND WHAT THEY DID THAT WAS SPECIAL
  
My doctor's first and last name: 
Staff who made a difference for me: 
 
 
TELL US THE BEST WAY TO CONTACT YOU
Any information you provide will be used only to contact you.  
Email Address: 
Telephone number: 
Best time
to call: 
Please attach a photo of yourself for the blog. 
Authentication * 

If the challenge words are too difficult to read, click here to refresh.
 

Note: If your story is posted to the YOU 101 Blog, it maybe edited for length do to space on the blog.

We will treat your information with absolute respect for your privacy. If your story is selected, we will be in touch with you to talk about how we can best tell it. That might be on the Web, in print, or on video.

Nothing in this form will be posted in public until we have contacted you.

Please don't include information such as medical record numbers, social security or financial information.

See more of our patient stories.
 
PeaceHealth.org  |  Careers  |  Notice of Privacy Practices