Customer Services Feedback Form

How are we doing? We rely on feedback from you to let us know how we are doing and to help us improve. Please tell us:

  • When things are better than expected
  • Any suggestions for improvement
  • When you are not satisfied
Please fill out all the fields below:

Name

Email Address

Postal Address (All complaints are responded to in writing so please provide a valid postal address below)

Telephone Number

Name of Patient (if not the complainant)

Date of Occurence

Service/Department: (eg Maternity, Outpatients, Emergency etc)

Hospital:
Base
Hawera
Health Centre

Your Statement

Are you a (tick a box):
Patient
Relative
Visitor
Customer

 

Last updated: Wednesday, January 25, 2017

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