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To send a greeting to a patient currently staying at Smithville Regional Hospital, please fill out the following form completely, if form is incomplete, your e-card will be voided. Your message will be printed at our Admissions desk and hand-delivered by one of our volunteers. Every effort will be made to ensure your greeting is received in a timely manner. *REQUIRED INFORMATION
PATIENT INFORMATION:
*Patient's First Name:
*Patient's Last Name:
Patient's Room Number:
INFORMATION ABOUT YOU:
*I am the patient's:
If other, please specify:
*My First Name:
*My Last Name:
*Address:
*City:
*State:
*Zip Code:
*Country:
*Daytime Phone:
*E-Mail
Message:
Click "Submit" one time. Click "Home" button to return to home page.

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