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Patient Concern Form 

Ensuring that patients have access to quality, convenient care and that they are treated with respect across the health care spectrum is important to us.

If you have had an unpleasant experience at a hospital, doctor’s office or in another medical environment in the north country, please let us know by completing the Patient Concern Form below. Your information will remain confidential if you wish for it to.

Time
:
Date
Is this a confidential complaint?
Yes
No
Is this an anonymous complaint?
Yes
No
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