Donor Interest Survey
*
1.
First Name:
(Required.)
*
2.
Last Name:
(Required.)
*
3.
Email:
(Required.)
*
4.
Preferred method of contact:
(Required.)
Email
Snail Mail
Phone Call
Do Not Contact
5.
What type of events interest you(select all that apply)
Gala
Golf Tournament
Casino Night
Wine/Beer/Spirits Tasting
Social Events/Donor Appreciation
Milestone Events (groundbreaking, ribbon cutting, grand opening, etc.)
Community Health Education Seminars
New Medical Technology Demonstrations
Medical Facility Tours
Other (please specify)
6.
Which Peterson Health programs do you care the most about (select all that apply)?
Intensive Care/Emergency Services
Therapy/Rehab
Heart and Vascular
Women's Health
The Baby Place
Surgical Technology Upgrades
Joint Replacement
Wound Care
Peterson Hospice/Home Care
Medical Staff Education
No preference
Other (please specify)
7.
What type of updates would you like to receive from Peterson (select all that apply)?
Current Events at Peterson Health
Physician/Personnel updates within Peterson
Construction Updates to the Peterson facility
Foundation Campaign Updates
New and Upcoming Treatment Methods
Financial Planning/Tax Tips
General Health and Wellness
Other (please specify)
8.
Why do you choose to support Peterson Health (check all that apply)?
I want to ensure the Hill Country community has access to great care locally.
It is important to me that Peterson Health is here to care for my family for future generations.
I want to help advance Peterson Health so that additional providers and service lines are available to meet the needs of our growing community.
Other (please specify)
9.
Do you have a story you would like to share?
Yes (tell us your story on the next page)
No
