Print a Hospital Letter

If you have had a hospital birth in the last 5 years, and would like to provide feedback to your hospital, please fill out the following questionnaire. It should take less than 10 minutes of your time. Once you submit the form, you will be able to preview, edit and print the letter to be signed and mailed to the hospital. (Note: A copy of the letter will be emailed to us for statistical purposes. You will not be on a mailing list or receive spam).

Step 1: Preliminary Information

Fields marked * are required.

Step 2: Labor & Birth

Step 3: Labor & Birth : Continued

Step 4: Add your own Text (Optional)

You can add up to two paragraphs of your own text to the content of letter body below: Please specify only one paragraph of text in each of the box below as that would ensure nice formatting of the letter. Click on Submit and Preview Letter once you are done with all the typing.