Stroke Survey Request

TETAF's credentialed and experienced surveyors provide consultative services for hospitals seeking Stroke Support Facility (Level III) designation. Services available include initial designation surveys, contingency surveys, and consultation surveys. Fill out the form below to request a survey.

PLEASE NOTE: If you do not receive a response within 24 hours contact Aaron Rogers at

Survey Request - Stroke

"*" indicates required fields

Hospital Information

Primary Point of Contact - Contact Information

Stroke Program Manager - Contact Information

Stroke Medical Director - Contact Information

Chief Nursing Officer - Contact Information

Survey Request Information

Request Type*
Type of Survey*
Drop files here or
Accepted file types: pdf, jpg, png, Max. file size: 50 MB, Max. files: 5.
    MM slash DD slash YYYY
    Has your facility previously used TETAF/Texas Perinatal Services for your survey needs?
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