At UCS Healthcare, we want your treatment experience with us to be the best it can be. We're interested in your feedback on our programs and we take it seriously. We have three ways to provide feedback depending on what you’d like to tell us. If you’re uncertain about where to submit your feedback, please read the detailed descriptions below before sending anything to us.
All patients of UCS Healthcare are asked to take this survey. Just click the link – the survey takes less than five minutes and helps improve our programs.
Suggestions or Complaints
If you have an issue with the treatment, service or interaction you have experienced at UCS Healthcare, we want to know about it so we can address the problem. Similarly, if you have had a positive experience or have a suggestion for us, we want to hear about those thoughts and ideas as well.
Your message will be reviewed by the UCS management team with 24-48 business hours. If you would like someone to contact you, please include your name, the best phone number to reach you and your email address if possible. All feedback is confidential. As long you do not see this as a violation of your rights as a patient, please use this form. You can also email us at email@example.com.
This form is available in the lobby of each location as well.
UCS Healthcare defines a grievance as a perceived violation of a patient’s rights. The UCS Healthcare management team reads and responds to every grievance. You can ask for a printed copy at the front desk of any UCS location. If you’re not sure what your rights are, please read the section below, “What are Patient Rights?”.
Please choose to download a PDF or a Word document located below, print the form, complete it and bring it to UCS or email it to firstname.lastname@example.org.
What are Patient Rights?
- You have the right to be at the center of our treatment model and to manage your long-term recovery process.
- You have the right to an individualized path to recovery. The team at UCS Healthcare will help you find the path that works best for you based on evidence based information about treatment and alternatives, medications and treatment modalities UCS Healthcare provides care in the least restrictive environment available.
- You have the right to provide UCS Healthcare with feedback regarding your care and expect the team to be responsive to your feedback.
- You have the right to be informed in person and in writing about the rules and regulations associated with your involvement with UCS Healthcare.
- You have the right to be treated fairly regardless of your race, gender, gender expression, gender identity, age, sexual orientation, ability to pay or other demographic information.
- You have the right to be treated with dignity, respect and freedom from abuse, humiliation or neglect and you have the right to be protected from the behavioral disruptions of other patients.
- If you are not treated professionally, you have the right to file a complaint/grievance without fear of retaliation. You have the right to receive a decision in writing and the right to appeal to unbiased sources.
- You have the right to decide to share your personal information with us and to sign a release if you want us to share it with anyone else. We will not share information about you without your written permission, unless you are at risk of harming yourself or someone else.
- You have the right to review your file or have a copy of your records at your request. You have the right to discuss the information contained in your file with your counselor/therapist or a program supervisor at any time.
- You have the right to be aware of how much treatment services will cost and the different ways you can make a payment. If you are denied services, you have the right to know why and to make a complaint or file a grievance if you believe the decision is unfair.
- You have the right to be free from financial or other exploitation.
- You have the right to have access or referral to: legal entities for appropriate representation, self-help support services and advocacy support services.
- You have the right to adherence to research guidelines and ethics if applicable.
- You have the right to investigation and resolution of alleged infringement of rights.
- You have the right to other applicable legal rights.