FAIRFAX MEDICAL FACILITIES, INC.
PATIENT COMPLAINT FORM

Please fill out this form in it’s entirety.  Incomplete forms cannot be processed.  Please allow 48 to 72 hours for a response.

**DISCLAIMER** The electronic form below is sent to our administration via unsecured email.  If you are not comfortable with this you may download a printable form linked at the bottom of this page.

PATIENT COMPLAINT RESOLUTION FORM

Right click and save the following link for a printable complaint form:  PRINTABLE PATIENT COMPLAINT FORM Please mail a filled out form to Jenette Chambers DON 160 N. Main Fairfax, Oklahoma 74637.