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Get Patient Feedback Form
How it works
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Open form follow the instructions
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Easily sign the form with your finger
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Send filled & signed form or save
How to fill out the Patient Feedback Form online
Filling out the Patient Feedback Form is an important step to communicate your healthcare experiences. This guide will walk you through the online process, ensuring it is clear and straightforward.
Follow the steps to effectively complete your feedback form.
- Click the ‘Get Form’ button to obtain and open the Patient Feedback Form in a digital format.
- Begin by entering your personal information. Provide your full name, date of birth, address, and contact information, including both phone and cell numbers. Make sure that all details are accurate.
- Identify who is submitting the form by filling in the 'Submitted by' section and, if applicable, including your medical record number.
- Indicate whether your concern is related to your bill or your patient care by selecting the appropriate checkbox.
- Answer the question regarding whether you have discussed your concern with a member of your healthcare team by selecting 'Yes' or 'No.'
- Provide a brief statement detailing the issue. Include information on who was involved, when and where the issue occurred, and a description of what happened. If additional space is necessary, feel free to use the back of the form or attach supporting documents.
- Sign and date the form to authorize the OHSU Patient Advocate to review your concern and represent your interests. Ensure that your signature is clear.
- After reviewing all the entered information, proceed to save changes, download, print, or share the completed form as needed.
Take action today by completing your Patient Feedback Form online.
To ask patients for reviews, provide a simple template that outlines what you need from them. Include a link to your Patient Feedback Form, and express gratitude for their time. A friendly reminder after their appointment can significantly increase the likelihood of receiving valuable feedback.
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