Feedback Form

(to be completed by the client/client’s family member/caretaker)

United Indian Health Services, Inc. welcomes all feedback as an opportunity to improve services. All clients have the right to give feedback related to the delivery of health care for any service at any of our sites. Completing this form will not compromise access to future care.

Complaint Form

*Name optional – if your feedback is related to your care, omitting your name could limit our ability to fully investigate the issue or come to a resolution on your behalf
MM slash DD slash YYYY