Customer Compliment / Concern Form

The Patient Experience Department serves patients and families who have compliments or concerns regarding their care at Sparrow. This form is secure and all information submitted will remain confidential.
  
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The Topic of Your Message
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Your Name
Your Relationship to the Patient
Name of Patient
Type of Service
Date of Service and/or Incident
Location
Please describe your compliment or concern:
Please list the names of the employee(s) or physician(s) involved in this occurrence (if known).
Telephone Number

Please include area code and dashes (ex: 517-123-1234)

Best Time to Call
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Email Address
Preference of Contact

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