Two Rivers Family Health Team is committed to providing excellent service to our patients. If you are unhappy with our service, you may submit your complaint using the form below.

Alternatively, if you would simply like to provide feedback about your recent visit, please click on this link to access our Patient Experience Survey.

We listen to your complaints, treat them seriously, and learn from them so that we can continuously improve our service.

Formal complaints procedure:

Complete the “Complaint Report” below and click “Submit”.
Our Clinic Manager will then meet with the management team to review your complaint.
If needed, your complaint will be reviewed with other healthcare team members. In some cases, we may ask you to meet with members of our team to review the complaint.
If you would like a response from our management team, you will be contacted within four weeks of submitting your complaint. If this timeline cannot be met, a member of our team will let you know when you can expect a response.

Complaint Report Form

Date of the Incident(Required)

Time of the incident(Required)

Location/Unit # of the Incident(Required)

Person(s) involved (physician and/or clinic staff)(Required)

Names of people involved (if known)(Required)

Description of incident (what occurred, when, where, who was involved)(Required)

Patient Name(Required)

Please provide the name of the person completing the form, if different than the patient.

Email(Required)

Phone number we may contact you at(Required)

Please select your family doctor:(Required)

Do you give consent to share this complaint with your family doctor/staff member?(Required)

Yes

Would you like a call from Management regarding your experience?(Required)

Yes

I confirm that this is NOT a personal medical question(Required)

Agree

Phone

This field is for validation purposes and should be left unchanged.

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Formal complaints procedure:

Complaint Report Form

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Formal complaints procedure:

Complaint Report Form

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