Compliment
Complaint
Question
Suggestion

If this concerns a visit you have made to the Emergency Department, please supply us with:

When you were in the ED:
Why you were there: 
Which doctor(s) treated you:

Please give us your comments. Please be as specific as possible, and indicate any actions you wish us to take.

Your name (optional, but we would really like to get back to you:)

Is there a telephone number where we can contact  you?

Is there an e-mail address where we can contact you?

Thank you.  You should hear from us in 72 hours or less.