If You Have a Concern

Providence Medical Group takes each patient concern within our group seriously. Below, please describe in detail the incident in question so that our Medical Compliance Officer can address it with the appropriate personnel and/or provider.

It is our goal to respond to a concern within 48 hours of receiving it.

Thank you in advance.

Providence Medical Group
Complaint Form

 

Information About You

Please provide a number where you can be reached


Provider


Complaint

Please describe your complaint as completely as you can. Please date the form.