HBCH Drawing Entry

Enter a drawing to win a $10 gas card.

The Harbor Beach Community Hospital will hold a quarterly drawing of all patients who completed the Satisfaction Survey from the Harbor Beach or Port Hope Medical Clinics. Two $10 gas cards will be awarded each quarter.

To enter the drawing, complete the contact information below. Your name will not be linked to the answers on your survey.

Question Title

* 1. Contact Information

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number: