Complaints/Kudos Patient Feedback Form First Name * Last Name * Classification – Choose * 1) Patient2) Family member of patient3) Friend of patient4) other explain Classification – Choose Contact number * Location of incident (zone) * North ZoneEdmonton ZoneCentral ZoneCalgary ZoneSouth Zone Download Zones Map Type of Feedback * 1) Compliment for staff2) Suggestion for Improved Services3) Concern about care received Feedback Description * HIA/FOIP statement Personal or health information collected will only be used for the purpose of tracking, follow up, communications and trending regarding your health experience concern. Information is collected pursuant to section 33 of the Freedom of Information and Protection of Privacy Act (FOIP) and under the authority of Section 20(b) of the Health Information Act (HIA) for the purpose of administering AHS' patient complaint and feedback program. reCAPTCHA If you are human, leave this field blank. Submit Δ
