Healthicity Audit and Compliance Solutions

Alcona Citizens for Health Inc.

Alcona Citizens for Health, Inc.'s Patient Feedback Form

Welcome to Alcona Citizens for Health, Inc.'s (AHC's) patient feedback form!

We value your feedback as we look to recognize staff/processes and learn from your experiences.
We want to hear directly from our patients!

If you have an urgent concern or wish to talk to staff directly, please call your local Alcona Health Center.
Use this link to look up contact information for any Alcona Health Center Location: Locations – Alcona Health Center (alconahealthcenters.org)

Date observed or first noticed

Clinic Location:

Other Clinic Location:

Who or what was affected?

Description of event(s) or concerns

Would you like us to reach out to you to discuss this further?

If yes, please enter your contact information:

Do you want to save a copy of this report to your device? YesNo

Thank you for taking the time to complete this feedback form.

AHC appreciates all honest feedback provided as it aids AHC to make improvements in order to provide the best care possible as well as recognize staff that have made your experience memorable.