Complaint's registration Form

Yazd, Mahdieh Square, beginning of Imam Jafar Sadegh Blvd.

Health tourism

We turn every complaint into an opportunity to improve patient treatment.

Tracking Code

Complaints Occurrence Date & Time

Which department are you complaining about?

Doctors Name

File Number

Receptions Date

Discharges Date

Complaints Cause

Name and Post of the person you are complaining about

Complainers Education

Complainers Occupation

Address

Phone Number

Select the complainer

Patient

Accompanying the patient

Other

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Full Name & Signature

Description of the Complaint

Full description of the complaint (Who? When? Where? Who involved in it?)

Follow up information — keep this section

Dear applicant: Keep this section in your memory and follow up on your complaint a week later through tracking code.

Code Tracking

Date and time of complaint

SMS Number

Phone number: 035-33182261 | Internal number: 261