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Patient Compliments & Complaints Form

It is the goal of Rochester General Health System to provide high quality care with compassion. We appreciate any compliments or complaints regarding patient care and services received with us. You may (securely) send compliments or complaints about the care that you or a loved one received to our Patient Relations Coordinator using the form below. This form can be used for all Rochester General Health System locations and practices.

We take your feedback seriously and appreciate the opportunity to know what's working well and what improvements need to be made to meet the needs of our patients. 

Note: Please do not use this form for anything other than patient compliments or complaints. If you submit a message that is not related to a patient care experience, it may not be answered. For general questions and assistance, please use our email us form or call us at (585) 922-4000.

* = Required Field

 

Your Information

* Your Name:
* Patient's Name:
(if different from your name)
Patient's Date of Birth:
(format: 00-00-0000)
* Hospital or facility where patient received care?

Date(s) of care:
(please provide the approximate date(s) when the patient received care)

 

Best Way to Contact You

* Home Phone:
Cell:
Work Phone:
Other:
* Email:
 

Compliment / Complaint

* Please include your compliment / complaint in the box below. Any details of care / services provided, health care provider names and explanation of your situation will better help us direct your feedback to the appropriate person(s) and follow-up on the information that you have provided.