CHP Patient Relations Form

Tell us what you think

Please share any comments and/or concerns you have about your child’s care or the services provided by UPMC Children’s. Please do not disclose personal health or medical information. Thank you for your comments.

Date(s) of hospital visit: * to Hospital Unit/Clinic where your child received care (i.e., 8A): * Location: * Child’s first and last name: Your first and last name: Relationship to the patient: * Email: *
Your telephone number:
Your Comments: *

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