Gift of Life

Honor a Loved One on the Gift of Life Memorial Wall

Loved ones wishing to honor donors can share their loved one's story on the Gift of Life Memorial Wall, located on the first floor of the Stormont Vail Health Topeka Hospital Pavilion.

We would be honored to share your loved one's story with others – it may even inspire others to make the same noble choice to donate.

If you have questions about this form or issues submitting it, don't hesitate to contact Jana Tenbrink, Stormont Vail Nurse Manager, at (785) 270-4282 or email [email protected].

Please share and upload your picture here:(Required)

Accepted file types: jpg, gif, png, pdf, Max. file size: 98 MB.

We need your permission to feature your loved one’s image and story on the Gift of Life Memorial Wall. Please check the box below to agree to Stormont Vail Health’s media release policy.

Your Name(Required)

First Last

Your phone number(Required)

Your email address(Required)

Your Loved One’s Name(Required)

First Last

Was your loved one a patient of Stormont Vail Health?(Required)

Yes

The Memorial Wall was a donation to the patients of Stormont Vail Health. Please check where your loved one was served for options they have to celebrate their gift of life.

When did your loved one donate?(Required)

i.e. year of death

What did your loved one find meaningful?

What brought your loved one happiness?

How did your loved one become a donor?

Why did they choose to donate?

Feel free to add anything else you’d like to share about your loved one.

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Gift of Life

Honor a Loved One on the Gift of Life Memorial Wall