Express a Concern

Please complete the form below, which will be emailed to QHC's Patient Experience Specialist.

First Name*

Last Name*

Email Address*

Phone*

Date of Visit

Which hospital are you referring to?

Belleville General Hospital

Trenton Memorial Hospital

Prince Edward County Memorial Hopsital

North Hastings Hospital

General

Staff Name if applicable

Comment*

How would you like to receive follow up?

Phone Call

Email

Please do not contact me