IMD Guest House | Non-Profit Hospitality House

Please share your story with us by filling out the form below. IMD Guest House shares guest experiences on its website and through media platforms. If we select your story, we will contact you before sharing. IMD Guest House provides the comforts of home and the care of community to outpatients and the families of patients who must seek treatment away from home. Thank you for sharing your story.

First Name *

Last Name *

Email *

Phone Number

State

Zip

Institution or Referral Organization: *

American Cancer Society
Editha House Foundation
John H. Stroger Jr. Hospital of Cook County
Loyola Medical Hospital
Northwestern Memorial Hospital
Rush University Medical Center
Rush Road Home Program
University of Illinois at Chicago Hospital and Health Sciences System
University of Chicago Medical Center
Veterans Administration

Please select type of treament related to your story and experience: *

Cancer
Infectious Disease
Men's Health
Neurology
Pediatrics
Senior Health
Transplant
Veteran's Health
Women's Health

Other

Please share your story and experience below:

Please select your age group:

Under 18 (Your Child)
18-25
26-35
36-45
46-55
56-65
over 65

How did you hear about IMD Guest House?

Institution
Organization
Doctor/Healthcare Professional
Social Worker
IMD Guest House Brochure or Pamphlet
Family Member
IMD Guest House Board Member
IMD Guest House Jr. Board Member
IMD Guest House Staff or Administrative Personnel
IMD Guest House Website
Volunteer
IMD Guest House Guest
Email

Can we share your story and experience? *

Yes (We will contact you before doing so)
No

Please let us know if you have any questions or concerns:

Date *

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