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Patient Experience Form

Erlanger is important to this community, and the community is important to Erlanger. We desire to serve you and your family with the highest possible quality of care and to be your family’s hospital of choice for all your healthcare needs. If you were dissatisfied with your quality of care, or would like to express any compliments or concerns, please complete the following form to let us know about the experience. In 7-10 days you will receive a letter of acknowledgement with a report of the status of our investigation. However, it may take up to 30 business days for the investigation to be completed. If the review is not completed within 30 business days, a letter will be sent with an update in our investigation process. If this is a billing concern please contact Patient Financial Services at 423-778-5150 Patient/visitor Full Name:  *Date of Birth:  *Is this related to a patient in the hospital now:  *Hospital Location  *Hospital or outpatient area involved:  *Please describe your reason for contacting us:  *Your full name if not the patient/visitor:  *Your address if not the patient/visitor:  *Your phone or e-mail address if not the patient/visitor:  *Relationship to the patient/visitor:  *