Enter a Custom Message

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Who is this card from?

Your First Name *

Please provide your first name.

Your Last Name *

Please provide your last name.

Your Email Address *

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Send me a copy

(email required)

-OR-

Your Phone (555-123-1234)

Please use xxx-xxx-xxxx format.

Type Home Cell Work Fax Pager

Who is this card being sent to?

Recipient's First Name *

(no nicknames please)

Please provide the recipient's first name.

Recipient's Last Name *

Please provide the recipient's last name.

How should we deliver this card?

As an email message to a personal account

Recipient's Email Address

Recipient email address is not the correct format.

As a printed card delivered to a patient's hospital room

Location (Select One) Adventist HealthCare Shady Grove Medical Center Adventist HealthCare White Oak Medical Center

Recipient's Hospital Room Number