Share Your Story
We want to hear about your journey with Scottish Rite Hospital! Use this form to tell us about yourself, and upload photos and videos. If you have any questions, e-mail firstname.lastname@example.org.
Your Name (if different from patient)
Are you a former or current patient?
Parent / Guardian
Which Scottish Rite Hospital location do you visit?
City and State
Tell us your story.
Here are some questions to help get you started:
What symptoms prompted seeking medical attention?
How did you learn about the hospital?
How long have you been a patient and what is the state/progress of your treatment at this time?
How would you describe your overall experience at the hospital?
Favorite thing about coming to the hospital?
Favorite people on our staff, such as a doctor, nurses, therapists, someone at the registration desk or in the cafeteria?
What does Scottish Rite Hospital mean to you?
What are your favorite hobbies or activities?
How did you hear about Share Your Story?
Review the Terms & Conditions at
I agree to the Terms & Conditions.
I am willing to receive email communications from the hospital.
I would like to receive newsletters and information about upcoming events from Scottish Rite Hospital.
Upload Photos and Video Files
Share your story through photos and videos!
Send me a copy of my responses
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