Santo Domingo Health Center

Healthy People, Healthy Community, Healthy Lifestyle


Patient Complaint/Grievance Resolution (PCGR) Form

We are listening! If for some reason there is an issue when you come to our facility and our staff is not able to resolve your matter to your satisfaction, please let us know by completing the Patient Complaint Grievance Form. You can submit your form using the SEND button and it will be sent to our Patient Grievance Resolution Specialist. If you choose to be contacted, please ensure to provide your number and/or address so someone can be in touch with you. As always, you can stop by and have one of our staff members help you fill out a form for us to follow up with. Your concerns are very inportant to us and we address each response.




Please check the option(s) below which best provide a general description of the grievance reported. 



Please provide an objective account of your observations regarding this grievance.

Do you request a follow-up response? Yes No