Patient Feedback

Big Island Healthcare (BIHC) wants to meet your expectations. We welcome your comments and feedback. Our goal is to address situations when expectations are not met and follow up in a timely and reasonable manner.

Our practice administrator and staff are available to assist you with completing this form, presenting a formal complaint, or answering questions at (808) 885-3627.

Last Name

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First Name

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Address (optional)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Only add contact if you would like a follow-up; otherwise, you will remain anonymous

Phone Number

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Date of Birth

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Please call the office if you have any questions.

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Legal Representative Name

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If Legal Representative, state relationship

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Date

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