Medical Complaint Form Template Word | Patient Form

A medical complaint form is used by patients who are unsatisfied with his or her medical treatment at a hospital or with a general practitioner, the staff, or against the medical facility itself. This form will include the name, date, complaint to be made against, the type of complaint, and the details of the complaint. Also, the form should contain the resolution required by the complainant. The form should not contain any column for personal disputes with the medical and nursing staff and issues related with billing and payment will also not be concerned with this form. The medical complaint form template should be prepared according to the state mandatory laws and conditions. Below is a sample of Medical Complaint form.

Download online the sample Medical Complaint form template in either Microsoft Word or PDF format. Both the formats can be editable and customized as per requirements.

Sample Medical Complaint Form

Download Easy to Edit Medical Complaint Form at only $3.00

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