Hillsboro Area Hospital Hero:

Name:
Phone:
Email:
Age:
Occupation:
Services Received at Hillsboro Area Hospital:
Date of Services:
Is there a particular staff member you would like to recognize?
What are your thoughts or special quote regarding your care:
(Please limit them to 100 words.) When submitting this information, please note that we adhere to our published patient privacy policy.
Are you interested in appearing in our Patient Story campaign?
Please check here and a representative will contact you.
yes
no
May we contact you if we have any questions?
yes
no
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