Communication with the Ministry of Health (Suggestions/ Comments/ Complaints)

The fields marked with an * are mantadory.

APPLICANT INFORMATION
Name and Surname*:
Telephone Number*:
E-mail*:
APPLICANT INFORMATION
Name and Surname*:
ID Number*:
Telephone Number*:
E-mail*:
Relationship with the applicant*
SERVICE INVOLVED (Hospital/ Clinic or Department)*:
DESCRIPTION* (Please provide a brief description of the incident)
*
I confirm that with the submission of this electronic form, I accept that personal and any other information included, will be forwarded to the authorized officer for assessment and then to the respective departments for further evaluation and action.