Accessible Customer Service Feedback

The Brant County Health Unit is committed to providing exceptional programs and services to meet the needs of everyone in our community. To achieve this, we recognize the diverse needs of all residents and strive to provide services and facilities which are accessible to everyone, including those with disabilities. We welcome your comments to help us monitor and improve our services.

In addition to this form, you may also submit feedback in any of the following ways:
Mail or deliver to:	Brant County Health Unit, Corporate Services Department 194 Terrace Hill St. Brantford, ON N3R 1G7
Fax to:	519-753-2140
Email to:	email@bchu.org

Day of contact with us

Approximate time of contact

Did we respond to your service needs? *

YesNo

Was our service provided in an accessible manner? *

YesSomewhatNo (explain below)

Details of your experience

If you wish to be contacted by a staff person, please provide your contact information

Your full name

Daytime telephone

Address

Email address

Note: By providing your contact information you will authorize BCHU to contact you regarding your request. Your contact information will not be used for any other purpose.

This information is collected under the authority of the Health Protection and Promotion Act, Section 5 (or other appropriate legislation), and in accordance with the Personal Health Information Protection Act and the (Municipal) Freedom of Information and Protection of Privacy Act, for the purposes of providing public health programs and for statistical purposes. For information about the collection contact Co-ordinator, Freedom of Information & Protection of Privacy, Brant County Health Unit, 194 Terrace Hill St., Brantford, 519-753-4937 ext. 222.

The content of this form may not comply with the provisions of the Accessibility for Ontarians with Disabilities Act (AODA). If you are having difficulty using this form please contact Brant County Health Unit at 519-753-4937 for assistance. Thank you.

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Name

Reports