Comment Form

BURSA CITY HOSPITAL – COMMENT / COMPLAINT FORM

information about the person submitting comment and / or complaint (Please leave blank if you wish to remain anonymous. Your comments / complaints will still be considered by BRS Sağlık Yatırım A.Ş.

INFORMATION ABOUT THE PERSON SUBMITTING COMMENT OR COMPLAINT

Full Name
Date
Contact Information
Please provide necessary information based on how you wish to be contacted
Indicate your purpose:
Comment
Complaint
Recorded By
Person submitting comment/complaint
Other (please specify who)
If Recorded By field is "Other"
Your comments on the project
Information about your complaint
Date of Incident Regarding Complaint
One time incident/grievance
Happened more than once
On-going
Incident date / Number of Occurrences
What would you propose to resolve the problem?
Clarification text
I've read and I accept Clarification Text
Consent Text
I've read and I accept Explicit Consent Text