بیمارستان امام حسن سایت انگلیسی

1. Patient Information

Full Name

Passport Number/Patient ID

Nationality

Contact Number

Email Address

Date of Visit to the Healthcare Center

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2. Complaint Details

Date of Complaint Submission

Related Department/Unit

Medical Services

Staff Behavior

Financial Issues and Costs

Waiting Time and Coordination

Translation and Support Services

Other

Complaint Category

Detailed Description of Complaint

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3. Patient’s Request for Resolution

Patient’s Suggestion or Requested Action

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Phone Call

Messaging Application

4.Preferred Method of Communication

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5. Follow-up Information (To be Completed by the Center)

Reference Number

Date of Complaint Receipt

Person Responsible for Follow-up

Review Result and Actions Taken

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