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PATIENT PORTALMAKE A PAYMENT SCHEDULE APPOINTMENT

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712-722-1700
877-722-1770

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care@promisechc.org

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33 4th St NW,
Sioux Center, IA

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MAINTENANCE

HomeMAINTENANCE

Do NOT fill out form if this task is an EMERGENCY. Please contact Rebecca or a member of the leadership team if you have a Maintenance Emergency!

MAINTENANCE FORM

Please fill out this form if you require maintenance.

Maintenance/Cleaning Form Contact Name*
Maintenance/Cleaning Area - be specific which hall, room, office or area*
Maintenance/Cleaning Task*
Maintenance/Cleaning Task Date Request*
- Please add to the list for when our repair man/cleaning crew comes again
- Please have this task completed before the date below (please give explantation of why task needs to be completed before date)
Requested Date of completion and explanation
Give more details and information about exactly what task you chose above - give plenty of info so if maintenance man/cleaning crew comes when you are not here, they can still resolve the issue*

33 4th St NW, Sioux Center, IA 51250
Phone: 712-722-1700
Fax: 712-722-1770
Email: care@promisechc.org

PROMISE NEWS

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2022 HEALTHY HEROES EVENT
Jun 24
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This health center receives HHS funding and has Federal Public Health Service deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

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