SCHC Because We Care Form

Because We Care

You, or a person of your choice, have the right to present a grievance, complaint, and suggestion regarding health services to SCHC Administration, who will follow-up and respond in writing within ten (10) working days.

What do you want to report?(Required)

Good Job

Suggestion

Complaint

Incident

Date of report:(Required)

Location:(Required)

(i.e., lobby, exam room)

Who was involved?(Required)

(Names)

Describe the situation:(Required)

(give a general description of what happened)

Patient's Name

Optional

Please provide your mailing address for a written response:

Optional

Street Address Address Line 2 City State ZIP Code

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SCHC Because We Care Form

Because We Care

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