Patient Complaint/Resolution Form

Our patients deserve reasonable expectations of care and services provided while at Fibroid Institute. We are committed to addressing situations when those expectations are not met in a timely, reasonable, and consistent manner.

Our office manager and staff are available to assist you with completing this form, filing a formal grievance over the phone, or to answer questions at 214-838-6440.

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Please be as specific as possible with the following [1] please state your concern; [2] date of event; [3] time of event; [4] staff member(s) involved, and [5] location of event.
  • This field is for validation purposes and should be left unchanged.

Phone support is open from 9 to 5. We are always happy to answer any questions over the phone. If this is an emergency, please call 911 immediately.

Dallas fibroid clinics: T 214-838-6440 • F 214-838-6441
Houston fibroid clinics: T 713-903-3733 • F 713-903-3773

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