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STARS Recognition Form

STARS Recognition Form

STARS Recognition Form



Has someone at St. Mary's made you feel special?  Or gone out of their way to help you?  Would you like to recognize this individual?  You will find STARS forms throughout our facility, or you can send one utilizing this online form.  

This STARS Recognition form was made available to encourage colleagues, patients, families, associates, physicians, vendors or other customers of St. Mary's to acknowledge outstanding acts of kindness or extra efforts by any employee.

Please fill out the form below and we will forward your kind words to the employee and his supervisor so please be sure to submit the first and last name of the employee and the department or area in which they work.

* Indicates required information
Who are you recognizing? (Full name, if possible): * 
Name of department or nursing floor where they work: 
Tell us what made this person a STAR 
Your name: * 
E-mail address: * 
Date *  (mm/dd/yyyy)
I am: * 






If Other, please specify:

Authentication * 

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© 2014 St. Mary's Health System   |  3700 Washington Avenue  |  Evansville, IN 47750  |  (812) 485-4000