Thankyou

North Coast Radiology Group welcomes feedback about the provision of our services. If you would like to send any suggestions or have feedback please use the e-mail contact below.

Thank you for your comments.

Contact Details of Patient

*TYPE

Compliment     Suggestion     Complaint

*FIRST NAME

*LAST NAME

*ADDRESS

*PHONE

*EMAIL

Feedback Details

DATE OF INCIDENT

LOCATION CONCERNED

FEEDBACK SUMMARY

WHAT OUTCOME?

CAN WE CONTACT YOU?

Yes     No    

COMPLETED BY

Patient/Family Member     Staff Member    
Other