Submit a Complaint

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Do you have a complaint about the medical treatment, care, or quality of care you received at a USCHS hospital, including USC Arcadia Hospital or one of their affiliates?(Required)

Yes

By filling out this form and providing basic information on this secure platform, you are permitting the Monitor to open an investigation into your complaint. Please note that you must complete the Complaint Intake Form in one sitting. You cannot save it and return to it later.

In filing this complaint, I understand that my complaint, the information included in the complaint and the documents submitted in support of my complaint may be shared with the AGO, but not USCHS without my consent. When submitting a complaint or other information to the Monitor, I affirm that all information provided is true and correct to the best of my knowledge and understanding. Any materials provided are original documents or true and correct copies of the original documents and have not been altered.(Required)

Yes

Contact Information

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Does your complaint relate to a specific provision of the Conditions?(Required)

Please note the Condition in the AG's Conditions related to your complaint.(Required)

Please describe in general terms the alleged violation of the AGO’s Conditions.(Required)

Please describe when the alleged violation of the AGO’s Conditions occurred.(Required)

Have you filed this complaint anywhere else?(Required)

Yes

If yes, where?

Upload Documents

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By filling out this form and providing basic information on this secure platform, you are permitting the Monitor to open an investigation into your complaint. Please note that you must complete the Complaint Intake Form in one sitting. You cannot save it and return to it later.

Contact Information

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