Complaint Form

You can use this form to submit your complaint to the complaint mediators. We will use your personal information solely for the purpose of handling your complaint, and the complaint mediators are bound by a duty of confidentiality.

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Patient Information

Gender

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Complaint

What aspect does your complaint concern?

To what date or time period does your complaint refer?

Have you already discussed the complaint with the employee(s) involved?

Description of the complaint. You may use up to 5,000 characters.

What do you hope to achieve by filing your complaint?

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