Share Your Story

We want to hear about your journey with Scottish Rite for Children! Use this form to tell us about yourself, and upload photos and videos. If you have any questions, e-mail communications@tsrh.org.

Patient Name*

Your Name (if different from patient)

Are you a former or current patient?

Select or enter value

Patient Age

What do we see the patient for at Scottish Rite for Children?

Physician

Which Scottish Rite for Children location do you visit?

Select or enter value

E-mail Address*

Phone Number

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 organization? 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 Scottish Rite? Favorite thing about coming to the Scottish Rite? Favorite people on our staff, such as a doctor, nurses, therapists, someone at the registration desk or in the cafeteria?

What does Scottish Rite for Children mean to you?

What are your favorite hobbies or activities?

How did you hear about Share Your Story?

Review the Terms & Conditions at www.scottishriteforchildren.org/shareyourstory

I agree to the Terms & Conditions.*

I would like to receive email communications from Scottish Rite for Children about hospital news, events and giving opportunities.