Client Compliment Form
Do you have a compliment about the NHBP Health and Human Services Department's service(s) or the clinic's operations? We'd love to hear from you! Please fill out the form below.
Name (Optional)
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Time
Hour Minutes
AM
PM
AM/PM Option
Service Received
*
Please Select
Medical
Behavioral Health
Physical Therapy
Dental
Clinic Location
*
Please Select
Grand Rapids
Pine Creek
NHBP Health at FireKeepers
Description (Briefly describe the encounter, provide names, dates, times, location, etc. if possible.)
*
Who else was involved and how?
*
Would you like to be contacted by an NHBP Health and Human Services Department Manager or Director:
*
Yes
No
If yes, preferred phone number:
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred time of day:
Hour Minutes
AM
PM
AM/PM Option
Email
example@example.com
Submit
Should be Empty: