Share Your Kirby Story

Share Your Kirby Story

Help Us Celebrate 85 Years
(1941-2026)

Kirby Medical Center is celebrating 85 years of caring for our community, and we would be honored to include your memories in our anniversary celebration. Please use this form to submit a Kirby story, fun fact, or photo. Submissions may be featured on our 85th Anniversary webpage, social media, displays at celebration events, and other Kirby materials.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
What is your connection to Kirby? Patient, family member of a patient, employee, provider, volunteer/ Auxiliary member, community partner, or other?
Story or description of your Kirby story:
Upload Photo(s) (optional – file upload)Please upload up to ___ photos. Accepted file types: JPG, PNG. If your photo includes multiple people, please tell us who is pictured in the caption field below.Photo Caption(s) / Who is pictured? (optional)Example: “Front row: Mary Smith, RN (center). Taken at Kirby in 1986.”Approximate date of the photo (optional)Year (or best estimate) helps us place it on our timeline.

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Permission to Share & Media Release

I confirm this submission is my original story/ photo or I have permission to share it. I give Kirby Medical Center permission to use my submitted story and/ or photos for anniversary- related communications including 85th Anniversary webpage, social media, printed displays, promotional materials, and internal communications. I understand my submission be edited for length or clarity while keeping the meaning intact.
Permission to Share & Media Release Signature

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Sensitive Information Notice

Please do not include private medical details you do not wish to share publicly. If your story includes health information, share only what you are comfortable making public.
Thank you for sharing.

Your submission helps preserve Kirby’s history and celebrate the people who make our mission possible. If we have questions or would like to feature your story in a special way, we may contact you using the information provided.
Should be Empty:

(1941-2026)

Permission to Share & Media Release