Our Mission

to provide high quality digestive and endoscopic health care in a compassionate, comprehensive, cost effective manner while assuring the highest level of respect and integrity for the patient.

Feedback

In order to provide the highest quality of care, we welcome your feedback. Should you have any concerns or complaints please call (757) 481-4817 or complete the patient incident form.

Patient Name*
Address*
Telephone #*
Date of Birth*

Name of Person Initiating Complaint*
Address
Telephone # *
Relationship to Patient*
Nature of Complaint
Time & Date of Incident
Names of Staff Involved (if known)
In your own words please tell us why you are not happy with the care or service you received:
As a result of your complaint, what would you like to see happen?

I understand that staff investigating this complaint may need to see and review health records, but that all information will be kept confidential. I further understand that this complaint/grievance will in no way affect any care provided.

Signature
Date
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