Online Ratings and Reviews Comment Appeal Form
Provider First Name
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Provider Last Name
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Provider Email Address:
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Please copy and paste the comment text here:
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All comments that are appealed will be reviewed against the criteria below. Please check one or more of the following criteria that apply to this appeal:
Offensive language-profanity, discriminatory language, personal attacks or threats
Protected health information (PHI), or any information that could reveal a patient’s identity
Comments unrelated to the patient experience
Quality/Safety Issue
Other
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