Mercy Regional Health Center

Website Feedback

Mercy Regional Health Center - Website Feedback FormPlease use this form to report issues, request additions, and request changes/modifications regarding the new Mercy Regional Health Center and Via Christi websites.Mercy Regional Health Center will work in collaboration with the Via Christi Health System eHealth department to improve and maintain our new website. We will promptly address, respond, and seek to repair problems users find anywhere on the site. We also will review and follow up on all new page addition requests, new application requests and general feedback requests in a timely manner.

* Indicates required information
Name * 
Email Address * 
Type of User * 
If Other User Type Please Specify 
Type of Request * 
If Other Request Type Please Specify 
Location/Department * 
If Other Location Please Specify 
Is this a new request or follow up on an existing request? * 
Address (url "http://....") 
Description of Request * 
Authentication * 

If the challenge words are too difficult to read, click here to refresh.