HealthCare Trip - File a Complaint

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Please fill out the following form with full details so we can rapidly investigate your complaint against the HealthCare Tourism Organization Provider. You may use this information to file complaints against treatment providers, healthcare tourism agencies, transport companies, hotels, etc.

1. Select the country	2. Select the city where the
where the incident occurred:	incident occurred:

Please enter the organization's headquarter information (not necessarily where the incident took place)

Organization Name:*Required	Country:

Organization Street Address:	City:	State:	Zip Code:

Organization Phone Number	Type of Organization

Personal Information

Complete the information below if you would like the HealthCare Tourism International to notify you about any action taken on your complaint. Your name will be kept confidential.

Salutation:
First Name:
Middle Initial:
Last Name:
Suffix:
Professional Credentials:
Company Name:
Street Address:
City:
U.S. State or Country:
Zip:
Telephone:
Fax:
Email:
I am: *Required
Do you wish to remain anonymous? *Required

Incident Information

Incident Date:

*Required

Incident Narrative (Provide a brief overview of your complaint)*Required

Disclaimer

You may either provide your name and contact information or submit your complaint anonymously.   Providing your name and contact information will enable HealthCare Tourism International to inform you about the actions we have taken in response to your complaint and also will allow us to contact you in the event we need additional information. Either way, our policy maintains that we will treat your name and other information as confidential information and not to disclose it to any 3rd party.   However, it may be necessary to share the complaint with the subject organization in the course of a complaint investigation. Our policy forbids accredited organizations from taking any retaliatory actions against their employees for having reported quality of care concerns to HealthCare Tourism International. By clicking submit below, you agree to all Terms and Conditions as mentioned in our policies.

Contact Agreement

May we contact you if we need more information related to the incident? *Required