Home
About AHS
Contact
Patient Concerns & Feedback
Patient Feedback Form

Secondary menu

Contact
Patient Feedback Form

Patient Feedback Form

Important

Alberta Health Services values your input.

To share your ideas, suggestions, priorities & positive personal health stories, please visit Thank a Care Team!

If you have concerns related to a specific personal healthcare experience, please instead complete the BELOW form, and we will do our best to respond within three (3) business days. If you need to speak with a nurse you may call Health Link at 811 from anywhere in Alberta or if calling from out of province at 1-866-408-5465. If this is an emergency, please proceed to your local emergency services or hospital or call Emergency Medical Services at 911.

* indicates a required field

Your Information

First Name (required)

Last Name (required)

I am Select the option that best describes you (required)

A patient/client

A family member of a patient/client

A friend of a patient/client

A visitor/member of the public

Patient/Client name

First Name (required)

Last Name (required)

Contact Daytime telephone number (555-555-5555) (required)

Select the telephone number type (required)

Home

Work

Cell

Pager

Alternative daytime telephone number (555-555-5555)

Home

Work

Cell

Pager

Contact for hearing impaired with no TTY service

Email Address:

Please note that email is not a secure medium and the privacy of your information cannot be ensured. In providing your email address, you hereby accept and understand the inherent risk of transmitting your personal/health information through an unsecured medium. Patient Relations will not reply by email. A copy of the completed form will be sent to the email address provided.

Geographic Area Select the geographic area where the event occurred (required)

North Zone

Edmonton Zone

Central Zone

Calgary Zone

South Zone

Not sure what zone? Map of all zones

Name of Facility

Type of Feedback Select the type of feedback you are sending. (required)

Compliment for staff, physicians, or volunteers

Suggestion to improve health services

Concern about your care

Comments (required)

AHS protects the privacy of individuals receiving health services in accordance with the Health Information Act (HIA). To properly review and resolve any issues, we work with the patient, or an authorized representative (usually a close family member), to gather and share information about the services received in compliance with the Patient Concerns Resolution Process Regulation 28/2016.

Personal or health information collected will only be used for the purpose of tracking, follow up, communications and trending regarding your health experience concern. Information is collected pursuant to section 33 of the Freedom of Information and Protection of Privacy Act (FOIP) and under the authority of Section 20(b) of the Health Information Act (HIA) for the purpose of administering AHS' patient complaint and feedback program. For more information, or if you have questions or concerns about the collection, use or disclosure of your health information please contact Patient Relations at 1-855-550-2555 or Email: Patient.Feedback@albertahealthservices.ca

Report a problem Go to top

COVID-19 Information

Due to large volumes of inquiries the answer to the question you have on COVID-19 might be on one of these pages:

Book a Test
Cancel or Change a Test
Test Results (where to get)

More Info

We have been experiencing some problems with our online forms - if you are having trouble using this form please email Patient Relations at Patient.Feedback@albertahealthservices.ca.

Tell us about your health care experience!

Tell us about your health care experience - we want to hear from you. Please contact us if you have:

Compliments for staff, physicians, or volunteers
Suggestions to improve health services
Concerns about your care

Quick Reference

Contact Patient Relations Department
Patient Relations Poster
Patient Relations Brochure
Patient Experience

Report a problem

Header Links

Search

Search and menus