Complaint Form — Josco Multispeciality Hospital

1. About you

Patient's name *

MR number (UHID) — optional

Printed on the patient's card or bill. Leave empty if you don't know it.

Ward / room / department

Your name *

Your relation to the patient

Your phone number *

We will use this to reply to you. You will also need it to check your complaint.

2. What is your complaint about? *

Tick anything that applies (optional)

3. Tell us what happened *

What happened, where, and when (date / time if you remember).

4. What would you like us to do?

We have received your complaint