Report a Concern

If you have a concern about customer service received at any of our hospitals, clinics or health centers, fill out the form below. The information provided on this submission form is secure and confidential. A Clinical Safety staff member may contact and work with the patient’s health care team to address the issue.

If you have questions/concerns about how and under what circumstances animals are used for research purposes, please visit: Use of Animals in Research and Education at the University of Michigan or email.


Form

Patient's name:

Patient's MRN (from Blue Card), if available:

Patient's Date of Birth

Your name and relationship to patient, if other than patient:

Please describe your comment:

How do you prefer to be contacted?

  • E-mail:
    Note: While this form is secure, any future e-mail correspondence about this complaint is not. The chances of e-mail being intercepted or misdirected is not high, but if this is a concern for you, please provide a daytime telephone number instead.
  • Phone (provide number, including area code):