This form will be sent to: Alliance Health executives.
  • Personal Information

    Leadership will always carefully consider each submission and take appropriate action. When you provide your name, we can give you feedback on your submission. Anonymous submissions will not receive any news about our decision.

    Please be mindful that an issue cannot be addressed properly without an office location identified.
  • Specific Information

    Please fill in this section with specific information related to a patient complaint.
  • Please be as specific as possible.