PeaceHealth Peace Harbor Guardian Angel nomination

Form Description

Did a PeaceHealth caregiver make a meaningful difference in your visit to or stay at a PeaceHealth facility (PeaceHealth Peace Harbor Medical Center, PeaceHealth Medical Group, etc.)?

Please share your story with us 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:
(Caregiver, physician, nurse, or team)
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 Peace Harbor 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.

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