The pages accessible in English concern access to services and security in regard with health and social services in accordance with the French language charter. The Charter of the French language and its regulations govern the consultation of English-language content.

Complaint Form

USER’S IDENTIFICATION

Name:(Required)

Date of birth:(Required)

Medical record number (if known):

Telephone number:(Required)

Complete address:

Address Address (line 2) Town Province Postal code Country

Email:(Required)

Important

IDENTIFICATION OF USER'S REPRESENTATIVE (IF NECESSARY)

If, according to law, the user is represented in the filing of this complaint, identification of the representative is required:

Name:

Relationship to user:

Complete address:

Address Address (line 2) Town Province Postal code Country

Telephone number:

COMPLAINT

Date of event:

Place of event:

Who is involved:

Would you authorize us to send a copy of this complaint to the relevant manager?

Yes

Subject of the complaint:

Details of event:

Expected results: