Feedback – Integrated Care Concepts And Consultation

Please select which department your negative experience occurred:*

Please describe:*

Has your issue been resolved?*

Yes
No
In Progress/Requires Follow-Up

Were you satisfied with the resolution?*

Yes
No
Neutral

Follow-Up Information*

Please provide us additional information so we can best support you. Include the name of the staff member who has been helping with this issue and a brief description of what follow-up is required.

Does this experience impact your decision to continue services at ICCC?*

Yes
No
Unsure

Would you like us to contact you to explore this experience further?*

Yes
No
No Preference

Please provide us information for how your experience could have been better:

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