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Kimball Health Services

Kimball Health Services Patient Complaint Form

KIMBALL HEALTH SERVICES is committed to respecting your right to privacy of your personal health information and in providing quality healthcare. We take all complaints very seriously, and will not retaliate for filing a complaint. To file a complaint, complete this form.
  Complaint Submitted By: Patient
Other
  Patient Name
  Date of Incident (mm/dd/yyyy)
  Address
  City
  State
  Zip Code
  Nature of Complaint HIPAA Violation
Quality of Care
Billing
Customer Service
  Complaint Involves Clinic
Nursing
Radiology
Lab
Rehab
Outpatient Services
Social Services
Administration
Health Information
ED
Provider
  Description of Complaint