Complaint Form

Commissaire aux plaintes et à la qualité des services du CIUSSS de l'Estrie – CHUS

Step 1 of 5 - User's Information

Step 2 of 5 - Complainant information (if different from user)

If you file a complaint for a user, you do so in what capacity?
Note:
  • The complaint will be under the user’s name and he/she/they will receive the conclusion, unless otherwise specified by he/she/they..
  • Step 3 of 5 - Installation or person concerned

    Step 4 of 5 - Description of incident

    Step 5 of 5 - Autorisation et complaint preview

    The physician concerned by the complaint will receive a copy of this form in conformity with article 47 of the Act respecting Health Services and Social Services.
    Clicking « Next », you will be able to preview your declaration and may modify it if necessary before submitting it.
    * Field is mandatory.

    Transmission of data online | Confidentiality

    No personal data is permanently stored on our servers.

    When you provide your information through the secure forms of an appointment center, the information is sent through an electronic messaging system (e-mail) and may involve confidentiality risks.

    The CIUSSS de l'Estrie – CHUS cannot guarantee the confidentiality of information transmitted by e-mail.