Patient Relations Online Contact Form

If you have a concern about patient care, please contact us at 254-724-3035, or use the online form below. To protect your privacy and confidentiality, a Scott & White representative will address your patient care concern directly over the phone rather than responding via e-mail.

Use this form to submit a concern about care at Scott & White. For general comments, please use the General Questions online form.

If you have a question about your appointment, need to rescheudle or cancel an appointment, please contact your doctor's office.

Items with an (*) are required to process your request.
First Name*:
Last Name*:
Daytime Phone*:
E-mail*:
Your relationship to the patient.*: Parent
Patient
Child
Spouse
Other
Patient's First Name*:
Patient's Last Name*:
Patient's Date of Birth*:
Type your concern (limit 525 characters):
Mailing Address:
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Scott & White • 2401 S. 31st St. • Temple, TX  76508
• 254-724-2111 • 800-792-3710 • 254-724-3038 (TTY)
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