Trauma Survey Request

Hospitals are evaluated for Trauma Center Designation requirements, as defined by Texas Administrative Code 157.125. 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 - Trauma

"*" indicates required fields

Hospital Information

Primary Point of Contact - Contact Information

Trauma Medical Director - Contact Information

Trauma Program Manager - Contact Information

Chief Nursing Officer - Contact Information

Survey Information

Request Type*
Type of Survey*
Trauma Designation Level or In Pursuit*
Is this a contingency site review?*
Drop files here or
Accepted file types: pdf, jpg, png, Max. file size: 50 MB, Max. files: 5.
    MM slash DD slash YYYY
    MM slash DD slash YYYY
    Does your facility have the following:
    Has your facility previously used TETAF/Texas Perinatal Services for your survey needs?

    For Level IV Surveys Only

    Do you perform trauma surgeries on-site?
    Do you receive trauma transfers?
    This field is for validation purposes and should be left unchanged.