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Client/Patient Compliments and Concerns


  
Please fill in the applicable fields below by entering text into the text boxes below, when you are finished left click on the Submit button to send us your feedback. Thank you for your time.
  
Date:
  
Unit/Floor/Department/Program
  
Name of Staff
  
Description of Event/Issue
 
 
Please provide us with your contact number so that we can follow up! Leave it blank if you prefer to be anonymous.
Name:
 
Phone
 
Address: