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                                    Write a brief message:

                                    
                                    



                                    Patient's name:

                                    
	                                        



	                                        Patient's room number:

	                                        Note: 
	                                        
	                                        If the patient has been discharged place their 

	                                        email address below and it will be forwarded automatically. 
	                                        
	                                        

	                                        
                                    



                                    Your Name:

                                    
                                    



                                    Your email address:

                                    
                                    


                                    

                                    

                                    

                                    
                                    


                                    
                                    

                                

                            		
    				
                            
                        

                    

                    

    
                		
                
            

        

			
		  

		

	  

     

    


    
    
    
     
    
    


Pecos County Memorial Hospital District does not and shall not discriminate based on race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. Pecos County Memorial Hospital District is an equal opportunity employer.






    

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