CGCH Guardian Angels nomination

Form Description

Did a caregiver make a meaningful difference in your visit to or stay at PeaceHealth Cottage Grove Community Medical Center?

Recognize your caregiver(s) and we'll honor your Guardian Angel(s) with a special presentation. They'll receive a certificate and a specially-designed lapel pin in recognition of the exceptional care they provided.


Fill in the information below. Use the scroll bar on the right to move down the page. When finished, click the Save button located at the bottom of the form. If you would like to make a donation, fill in the amount at the bottom and you'll be taken to a secure site to enter your credit card information.

Questions marked with a red * require a response.

I/We would like to recognize:
(Department, physician, nurse or other caregiver)
I or a loved one received exceptional care in:
My/our story:
Sharing my story:

My information:
(Include area code)

When you make a donation of any amount in your caregivers' honor to PeaceHealth Cottage Grove Community Medical Center Foundation, they'll receive an angel wings lapel pin and certificate in a special ceremony.

Your gift helps us provide quality care, purchase new equipment and support ongoing programs. It's very possible that you or a loved one benefited from the generosity of past patients.

If you'd like to make a donation, enter the amount in the field above and click Save. You'll go to another screen where you can enter your credit card information.

Amount to charge credit card:
After saving this form, you will be asked for credit card information.