Thank you for your interest in Potomac Hospital's tours for children who are having surgery. Please complete and return this form electronically to arrange a tour for your child or for more information. A surgical team member will contact you by telephone or e-mail to confirm tour date and time.
Parent/Guardian's First Name:
Parent/Guardian's Last Name:
Name of Child Having Surgery at Potomac Hospital:
Child's Age:
Date of Surgery:
Surgeon's Name:
* Preferred Day for Tour
* Preferred Time for Tour:
* A surgical team member will contact you by telephone or e-mail to
confirm your tour day and time. We will make every effort to accommodate
your preferred day and time.
