MyAidRx Complaint Form

Patient Concern and Complaint Form

We want to provide your medication therapy and patient experience to your complete satisfaction. If you are not happy with the care or services we have provided, we want to know about it. If you have any concerns or problems with your medications or services, you can contact us at 844-795-2022. We will be glad to help you with any concerns. If you wish to file a written complaint you may do so using this form. We take all concerns very seriously and view them as opportunities to improve our services.

Patient Name*

Date of Concern/Complaint*

Date

Employee involved if applicable

Nature of problem*

Complete description of concern /complaint *

AIDRx does not discriminate on the basis of race, color, national origin, religion, age, sex, gender, sexual orientation, or disability.