Consolidated Tribal Health Project
Healthy People. Healthy Families. Healthy Community.

Patient Feedback Form

Patient Feedback Form

 

Please share with us comments and suggestions to help us continue to improve our services and quality of care. Comments are greatly appreciated, as our staff work very hard to serve you. It’s important to know what we are doing well, so that we may continue to do so.

We’re always open to helpful suggestions. You are welcome to submit a complaint when you feel that you need assistance in addressing a concern or resolving an issue.

Patient Info
Patient Name *
Patient Name
Patient Phone
Patient Phone
Patient Address
Patient Address
Comment / Incident Details
Date of incident
Date of incident
Preferred methods of contact