Concerns or Complaints
While Valley Health Care strives hard to maintain positive relationships with all persons who receive care from us, we realize that from time to time a patient may have feedback (concerns or complaints) about one of our policies or one of their experiences while in our office. Your feedback is important to us and we invite you to make note of your concern or complaint so that we can do everything within our power to provide quality services to our patients.
Please log your concern or complaint below:
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Date
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Month
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Day
Year
Date
Please note that your concern or complaint will be taken seriously and we will review it promptly. If you wish to receive a response, please include your name, date of birth and contact information below
Patient Contact Information
Patient Name:
Date of Birth:
Email:
Telephone #:
Person Completing Form:
Relationship:
Thank You
Valley Health Care Operations Management Team
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