We want to hear from you!
We welcome comments from patients, families, visitors, other service providers and members of the public. You may complete this form and submit by clicking the button at the bottom of the page. If you prefer to print and email or mail this form, please click here.
Date:
Are you a: (check the one that best applies)
Patient Family Member/Friend/Caregiver Substitute Decision Maker External Health Professional/Agency Other
What type of feedback would you like to provide:
Compliment Suggestion Complaint
Have you spoken to staff about your feedback?
Yes No
How are we doing? Please describe your feedback:
What would you like to see happen as a result of giving your feedback?
If you would like someone to respond to you, please fill out the following:
Name:
Email:
Phone #: Can a message be left at this number? Yes No
Patient care unit or program if applicable:
If this form was completed by a staff member on behalf of a patient:
Name of staff member:
Unit/Program: Ext.: