Please complete this secure form to submit your care concerns or feedback electronically. 

The personal information requested on this form and any additional information required by the Patient Care Quality Office in reviewing the care quality complaint submitted by or on behalf of an individual is collected under the authority of the Patient Care Quality Review Board Act and section 26(c) the Freedom of Information and Protection of Privacy Act, and will be used only for the purpose of reviewing this complaint. All persons obtaining personal information under the Patient Care Quality Review Board Act are under a duty of confidentiality with respect to that information. The authorization you complete below becomes effective on the date this form is submitted and remains in effect until the review is completed.

If you have any questions about the collection, use or disclosure of this information please contact the:

Patient Care Quality Office
Royal Jubilee Hospital
Memorial Pavilion
Watson Wing, Rm 315
1952 Bay Street
Victoria, B.C.
V8R 1J8

250-370-8323
Toll-free: 1-877-977-5797
Fax: 250-370-8137

patientcarequalityoffice@islandhealth.ca

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