Patient Info Gender Female Male Non-binary Prefer not to say Prefer to self-describe Reason for Admission Admission Month & Year Did you receive an Admittd duffle? The Duffle The Mini Duffle No How satisfied were you with the Admittd duffle? Favorite item? Least favorite item? What’s missing? If no duffle, how did you hear about Admittd? Care Unit Info Hospital Care Unit Number of nights admitted Who would you like to thank? Your ward nurses, healthcare aides & unit clerks Emergency Room nurses, healthcare aides & unit clerks Operating Room nurses & unit clerks Allied Health Professionals Thank You Note Your Name (optional) Name(s) of nurse(s) / AHP(s) If AHPs, which specialties? Physiotherapy Occupational Therapy Respiratory Therapy Social Work Other Upload a photo (optional) Donation Donation To Care Unit Selected Above Donation Amount All net-proceeds are pooled with other patient donations and gifted directly to your nurses and AHPs. For donations to support other healthcare causes, please visit the Calgary Hospital Foundation. Submit
