Complaint Form

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Please complete this form in its entirety. Completed forms must include complainant contact information or they will not be considered. The 缅北禁地 does not have investigative authority over accredited EDX laboratories or laboratory personnel. However, 缅北禁地 is able to review complaints and can request relevant information from the accredited EDX laboratory. The accredited EDX laboratory is only required to provide information that relates to its accreditation. Issues unrelated to the laboratory鈥檚 accreditation cannot be reviewed by the 缅北禁地. If a complaint is found to be unrelated, the complainant will be notified and, where appropriate, directed to the appropriate oversight organization.

Your Contact Information

Name*

Street Address*

City*

State

Zip Code*

Phone*

Email*

I am a(n) _______ of the accredited EDX laboratory in question (select answer that applies)*

Employee

Patient

Outside Practitioner

Other...

EDX Laboratory You Are Filing Complaint Against

Laboratory Name*

Lab Medical Director (if known)

Contact Person (if not Medical Director)

Street Address*

City*

State

Zip Code*

Phone Number (if known)

Email (if known)

Is the laboratory accredited by the 缅北禁地?*

Yes

No

Don't know

Please provide a brief description of the complaint*

Please describe any attempts you have made to resolve this complaint*

New code

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By submitting this form, I hereby attest that the information I have provided is factual and correct to the best of my knowledge. Further, I understand that by submitting this form to 缅北禁地, I am agreeing to be contacted in regards to this complaint. I also understand that 缅北禁地 will make every effort to keep my complaint anonymous, circumstances may require 缅北禁地 to share some information with the EDX laboratory. In such circumstances, 缅北禁地 will contact me prior to sharing my name or other identifying information.