Patient Feedback - Summerville Family Health Team

Patient Feedback

At Summerville Family Health Team, we are committed to ensuring that you have the best possible experience, from booking your appointment to visiting your health care provider and then follow-up. We value your feedback! If you experience a problem, or have a compliment, we would like to know.

Please feel free to complete the feedback form below and it will be reviewed by the Executive Director (ED) of Summerville Family Health Team. The ED will address the feedback directly with the staff involved. If it is a complaint and involves one of our doctors' staff, the ED will contact the relevant site manager or your physician. If a complaint involves a physician, the ED will contact the physician and the physician lead if necessary. If it relates to a medical resident or other learner, the ED will contact the supervising physician/manager. In all cases, your own physician will be informed.

All feedback received, as well as any resolution, will be recorded for quality improvement purposes. If the matter involves a clinical issue, it will be documented in your personal medical record.

Patient Name:

I prefer to be anonymous

If you are writing on behalf of another patient, please write your name and relation to the patient here

Name:

Relation:

Contact Information
(phone, email or address):

Description of Feedback:

If this is in regard to a concern, do you have any suggestions on how your concern could be addressed?

This form will be reviewed by all persons involved. An anonymous version of this form will be reviewed by Summerville’s Quality Improvement Committee to identify and develop solutions for patient issues. If you would prefer that this form is not used for Quality Improvement initiatives, please check the box below:

Not for use in quality improvement initiatives: