Good SamaritanPatient and Visitor Information

Email A Patient

Thank you for using the email a patient module. Emails are delivered to patients Monday through Friday, 9 a.m. to 4 p.m.  Emails sent after hours or on weekends will be delivered on the next business day.  

Thank you.

Please tell us the following:

(*) Starred items are required.

Patient's Information

Please use legal names so we can find them in our system.

Your Information
First and Last Name: *
Phone (to call if we have questions): *
Email (so that we may send you a confirmation):

How did you find our website?

Your message to the Patient:

Please make every effort to keep your message 500 words or less.


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