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STAR Form Online Submission

We appreciate your taking the time to submit this form. It will surely give one of our hard working employees a great pick me up!

Name of Employee, Volunteer or Physician:

Why does this person deserve a STAR?

Your Name:

Your Telephone Number:

Your E-mail Address:

Are you an employee/volunteer of or physician affiliated with Raleigh General?
 Yes       No 

Is there a specific person(s) to whom we should send additional copies of this submission? If so, please list their name(s) here:
 

Thanks again!
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Raleigh General Hospital
1710 Harper Road
Beckley,  WV  25801
Telephone: (304) 256-4100
Fax: (304) 256-4009
http://www.raleighgeneral.com