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CIHQ is a member-based organization comprised of hospitals
and other healthcare entities throughout the United States.
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CIHQ Accredited Hospital Complaint/Concern Reporting Center
Please complete the following information.
Your personal information is confidential and will not be shared with the accredited organization without your consent.
Contact Information
* Your Name:
* Address:
* City:
* State:
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* Zip:
* Telephone:
* Email:
* Confirm Email:
* Are You the Patient:
Select one...
Yes
No
* If Answered No Above, Relationship to the Patient:
Patient Information
* Name of Patient:
* Age of Patient:
* Gender:
Select one...
Male
Female
Accredited Organization Information
*Hospital:
Select one...
Albuquerque-AMG Specialty Hospital - Albuquerque, NM
Arkansas Continued Care Hospital of Jonesboro - Jonesboro, AR
Atrium Medical Center - Stafford, TX
Baptist Hospitals of Southeast Texas - Beaumont, TX
Black Hills Surgical Hospital, LLP - Rapid City, SD
BridgePoint Hospital National Harbor - Washington, DC
Carolinas ContinueCARE Hospital at Pineville - Charlotte, NC
Carolinas ContinueCARE Hospital at University - Charlotte, NC
Carson Tahoe Continuing Care Hospital, Inc - Carson City, NV
Carson Tahoe Regional Healthcare - Carson City, NV
CHI Memorial Hospital - Georgia - Fort Oglethorpe, GA
Cobalt Rehabilitation Hospital Fargo - Fargo, ND
Cobalt Rehabilitation Hospital New Orleans - New Orleans, LA
Cobalt Rehabilitation Hospital Of Surprise - Surprise, AZ
Cobalt Rehabilitation Houston Heights - Houston, TX
ContinueCARE Hospital at Baptist Health Corbin - Corbin, KY
ContinueCARE Hospital at Baptist Health Madisonville - Madisonville, KY
ContinueCARE Hospital at Baptist Health Paducah - Paducah, KY
ContinueCARE Hospital at Medical Center Odessa - Odessa, TX
ContinueCARE Hospital at Palmetto Health Baptist, Inc. - Columbia, SC
ContinueCARE Hospital of Tyler, Inc. - Tyler, TX
Cornerstone Specialty Hospitals Austin - Austin, TX
Cornerstone Specialty Hospitals Clear Lake - Webster, TX
Cornerstone Specialty Hospitals Conroe - Conroe, TX
Cornerstone Specialty Hospitals Little Rock - Little Rock, AR
Cornerstone Specialty Hospitals Medical Center - Houston, TX
Cornerstone Specialty Hospitals Muskogee - Muskogee, OK
Cornerstone Specialty Hospitals Shawnee - Shawnee, OK
Cornerstone Specialty Hospitals Southeast Arizona - Tucson, AZ
Cornerstone Specialty Hospitals West Monroe - West Monroe, LA
Covington-AMG Rehabilitation Hospital - Covington, LA
El Paso LTAC Hospital - El Paso, TX
Everest Rehabilitation Hospital Longview, LLC - Longview, TX
Everest Rehabilitation Hospital Temple - Temple, TX
Freestone Medical Center - Fairfield, TX
Great River Medical Center - West Burlington, IA
Houma-AMG Specialty Hospital - Houma, LA
Icon Hospital - Humble, TX
Indiana Regional Medical Center - Indiana, PA
Jellico Community Hospital, INC. - Jellico, TN
Kell West Regional Hospital LLC - Wichita Falls, TX
Lafayette Physical Rehabilitation Hospital - Lafayette, LA
Lafayette-AMG Specialty Hospital - Lafayette, LA
Landmark Hospital of Athens - Athens, GA
Landmark Hospital of Cape Girardeau - Cape Girardeau, MO
Landmark Hospital of Columbia, LLC - Columbia, MO
Landmark Hospital of Joplin L.L.C. - Joplin, MO
Landmark Hospital of Savannah, LLC - Savannah, GA
Landmark Hospital of Southwest Florida, LLC - Naples, FL
Landmark Rehabilitation Hospital of Columbia - Columbia, MO
Las Vegas-AMG Specialty Hospital - Las Vegas, NV
Lompoc Valley Medical Center - Lompoc, CA
Midwest Surgical Hospital - Omaha, NE
Multy-Medical Facilitys Corporation - San Juan, PR
Nevada Regional Medical Center - Nevada, MO
North Alabama Specialty Hospital - Athens, AL
North Texas Medical Center - Gainesville, TX
OKC-AMG Specialty Hospital - Oklahoma City, OK
PIH Health Hospital - Downey - Downey, CA
PIH Health Hospital - Whittier - Whittier, CA
Pineville Community Health Center, Inc. - Pineville, KY
Pomerene Hospital - Millersburg, OH
San Gorgonio Memorial Hospital - Banning, CA
Shannon Medical Center - San Angelo, TX
Solara Specialty Hospitals Harlingen - Harlingen, TX
Solara Specialty Hospitals McAllen - McAllen, TX
Sonoma Valley Hospital - Sonoma, CA
St Charles Surgical Hospital - New Orleans, LA
Surgical Hospital of Oklahoma - Oklahoma City, OK
Texas Institute for Surgery - Dallas, TX
The Heights Hospital - Houston, TX
The University of Kansas Health System Great Bend Campus - Great Bend, KS
United Memorial Medical Center - Houston, TX
Val Verde Regional Medical Center - Del Rio, TX
* Address:
* City:
* State:
Select one...
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
* Zip:
* Date of Incident:
* Approximate Time of Incident:
AM
PM
Your IP Address:
3.215.182.36
* Location in Hospital (Care Unit) where Incident Occurred:
* Please describe the incident or nature of your complaint: (1500 Maximum Characters)
* Does CIHQ have permission to disclose your name/contact information when communicating with the hospital?
Select one...
Yes
No
* Have you informed the hospital about your incident/concern?
Select one...
Yes
No
* Do you wish to have CIHQ notify you of the results of our investigation?
Select one...
Yes
No
*Required fields
Center for Improvement in Healthcare Quality (CIHQ)
P.O. Box 3620
McKinney, TX 75070
Phone: 866-324-5080 | Fax: 805-934-8588
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