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Recovery from physical and emotional trauma can be a long road. Sharing your trauma experience below can offer a great platform for self healing, social support, further education, and improved trauma care at Valley Medical Center.

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* 1. Date of Valley Medical Center visit

Date

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* 2. Was this Valley Medical Center ER visit related to a trauma injury?

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* 3. Were you the patient?

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* 4. Healing sometimes includes sharing your journey to offer social support to yourself and others who are impacted by trauma (this may include VMC staff, other patients, and the community.) Please feel free to share your trauma experience, from what happened to how your life has been impacted:

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* 5. Optional upload pictures (this may be used with your trauma experience to share with other patients, VMC staff, or the community)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 6. Permission for Valley Medical Center to share your journey for social support to other people who are impacted by trauma? -This may include VMC staff, other patients, and the community.  (Patient identifiers can be removed.)

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* 7. Your Contact Info for Trauma Services (optional)- due to the busy nature of trauma care someone from Trauma Services will contact you within 14 business days. Thank you.

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