Complaints, Compliments and Feedback

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Please process this Complaints, Compliment or Feedback by completing below. The original feedback is lower on this form.
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Compliments, Complaints & Feedback

We would love to hear from you! Any thoughts, concerns or problems or great experiences you have had. Each and every bit of feedback we get helps us improve or continue to provide a great service. You can remain anonymous.
Feedback Type *

Compliment Complaint General Feedback
Is this a Quality Improvement Opportunity?

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Suggested Title?
Date Reported or discussed

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Are you willing to share your name so we can respond?

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Your Name

First Name Last Name
How should we respond?
OK, where would you like to meet

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The Address

Street Address

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City State / Province

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Your Phone Number
Your Email
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Details and comments *
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Anyone else know of this feedback? If so, who?
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What would you like as an outcome?
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Compliments, Complaints & Feedback