Accreditation Program Complaint Form
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Any information contained in this form will be shared with all parties involved as part of the investigation process.
Contact information
*
Name
*
Phone
e.g. 999-999-9999
*
Email
Complaint information
*
Complaint type
Diagnostic facility
Diagnostic Accreditation Program
Facility information
Name
Address
Diagnostic program
e.g. laboratory medicine
*
Detailed description of the complaint
*
Suggestions(s) for improvement