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* 1. First and Last Name 

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* 2. Contact Phone Number

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* 3. Teri’s Health Services takes all comments, complaints, and grievances very seriously. It is our goal to address all concerns as quickly as possible, ensuring your rights and clinical treatment are maintained. We invite you to complete this form, providing us with the details of the event or situation in question. A member of leadership team will reach out to you to address the issue and come to a resolution. We thank you for your feedback and appreciate choosing Teri’s Health Services for your treatment needs.

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