Mid City Feedback Center
Mid City
Mid City Feedback Center
Submit a feedback
General
Submit a Feedback
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Name:
Email:
Contact Number:
Address:
Date of Occurrence:
Complaint type:
Compliment for consultant or staff
Suggestions to improve services
Other
Relationship with Patient:
Self
Other
Feedback:
Before submitting please make sure of the following:
All necessary information has been filled out.
All information is correct and error-free.
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recorded the time of your submission