I require an interpreter.I require an Aboriginal and Torres Strait Islander Hospital Liaison OfficerI would like to compliment staff/departmentI would like to make a suggestion/share a concern
Are you the patient?YesNo
[group group-patientyes clear_on_hide]
Patient's Name
Patient's Date of Birth
[/group] [group group-patientno clear_on_hide]
Name*
Relationship to Patient
[/group]
Telephone (Business Hours)
Email
Facility/Person or Department you are commenting on
Comments
What would you like to see happen as a result of your comments?Please respond and contact me backNothing just wanted to extend my feedbackOther
