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href="https://muhc.ca/careers/work-life-balance" name="Work-life balance"> <strong>Work-life balance</strong> </a> </li> </ul> <ul> </ul> <ul> </ul> </div> </div> </li> <li class="wcag-btns"> <form class="form-inline desktop"> <button id="pageContrast" class="btn btn-default-outline" type="button"><img src="/themes/custom/cusm_theme/images/contraste.png" alt="Contrast" width="15"/></button> <button id="textSize" class="btn btn-default-outline" type="button"><img src="/themes/custom/cusm_theme/images/aaa.png" alt="Text size" width="30"/></button> </form> </li> <li class="loupe nav-item dropdown"> <a class="nav-link dropdown-toggle" href="#" name="icon" id="navbarDropdown" role="button" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false"> <img src="/themes/custom/cusm_theme/images/loupe.png" alt="Search" width="20px"/> </a> <div class="dropdown-menu" aria-labelledby="navbarDropdown"> <div class="container container-large"> <div class="views-exposed-form bef-exposed-form 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<button data-drupal-selector="edit-submit-search-solr" type="submit" id="edit-submit-search-solr" value="Search" class="input-group-text js-form-submit form-submit"> <img src="themes/custom/cusm_theme/images/loupe.png" width="20" alt="Search"> </button> </div> </div> </div> </div> </form> </div> </div> </div> </div> </li> <li class="nostyle"> <div class="topnavbar"> <div class="container container-large"> <ul class="right"> <li> <a href="https://muhc.ca/internships" name="Internships">Internships</a> </li> <li> <a href="https://muhc.ca/donate-now" name="Donate">Donate</a> </li> <li> <a href="https://muhc.ca/volunteering" name="Volunteering">Volunteering</a> </li> <li> <a href="https://muhc.ca/the-institute" name="Research Institute">Research Institute</a> </li> <li> <a href="https://muhc.ca/news-and-patient-stories" name="News">News</a> </li> <li class="langLi"> <a href="https://cusm.ca/commissaire/contact" name="Fran莽ais "> Fran莽ais <img src="/themes/custom/cusm_theme/images/angle.png" alt="" role="presentation" class="angle"/> </a> </li> </ul> </div> </div> </li> </ul> </div> <div class="intromobiletop"> <div class="container container-large"> <ul class="left"> <li>Welcome to the McGill University Health Centre</li> </ul> </div> </div> </div> </nav> </header> <div class="dialog-off-canvas-main-canvas" data-off-canvas-main-canvas> <div id="page-wrapper"> <div id="page"> <div id="block-muhccusmpagebannerblock" class="block block-cusm-custom-blocks block-cusm-page-banner-block"> <div class="content"> </div> </div> <div data-drupal-messages-fallback class="hidden"></div> <section class="singleDepartmentNavigation"> <div class="container container-large"> <div class="row justify-content-lg-end justify-content-md-center"> <div class="col-lg-8 col-md-6"> <ul class="singleDepNavList testmyriam"> </ul> </div> </div> </div> </section> <div id="main-wrapper" class="layout-main-wrapper clearfix"> <div id="main"> <div id="block-cusm-theme-breadcrumbs" class="block block-system block-system-breadcrumb-block"> <div class="content"> <section class="wrapBreadcrumbs" > <div class="container container-large"> <div class="row"> <div class="col-md-12"> <nav class="breadcrumbs" aria-label="Breadcrumb"> <ol> <li> <a href="https://muhc.ca/" name="Home">Home</a> </li> <li> <a href="https://muhc.ca/ombudsman" name="MUHC Quality and Complaints Commissioner - Ombudsman">MUHC Quality and Complaints Commissioner - Ombudsman</a> </li> <li> <a href="#" aria-current="page"> Contact us </a> </li> </ol> </nav> </div> </div> </div> </section> </div> </div> <style> .drop-down-item{ position: absolute; top:100%; z-index:10; } .btn-menu-item { border: none; text-decoration:none; color:#334060 !important; border-bottom: 5px solid transparent; } .btn-menu-item:hover { border-bottom: 5px solid #334060; } @media only screen and (max-width: 767px) { .drop-down-item{ position:relative; } .btn-menu-item { border: none !important; text-decoration:none; } } </style> <div class="container-fluid w-100 mb-3" style="background-color:#FA9B56;"> <div class="nav row justify-content-md-center" id="menu-container"> <div class="d-flex flex-column col-6 col-md-2 col-xl-2 p-0" style="height: fit-content;" > <a type="button" class="btn btn-danger shadow-none bg-transparent btn-menu-item" href="https://muhc.ca/ombudsman" style="font-size:1.2rem; text-decoration:none;">About</a> </div> <div class="d-flex flex-column col-6 col-md-2 col-xl-2 p-0" style="height: fit-content;" > <a type="button" class="btn btn-danger shadow-none bg-transparent btn-menu-item" href="https://muhc.ca/ombudsman/FAQ" style="font-size:1.2rem; text-decoration:none;">FAQ</a> </div> <div class="d-flex flex-column col-6 col-md-2 col-xl-2 p-0" style="height: fit-content;" > <a type="button" class="btn btn-danger shadow-none bg-transparent btn-menu-item" href="https://muhc.ca/ombudsman/resources" style="font-size:1.2rem; text-decoration:none;">Resources</a> </div> <div class="d-flex flex-column col-6 col-md-2 col-xl-2 p-0" style="height: fit-content;" > <a type="button" class="btn btn-danger shadow-none bg-transparent btn-menu-item" href="https://muhc.ca/ombudsman/contact" style="font-size:1.2rem; text-decoration:none;">Contact</a> </div> </div> </div> <div class="clearfix"> <main class="main-content col" id="content" role="main"> <section class="section"> <a id="main-content" tabindex="-1"></a> <div class="container container-large"> <div class="row"> <div class="col-sm-12"> <div id="block-pagetitle" class="block block-core block-page-title-block"> <div class="content"> <h1 class="page-title"><span>Contact us</span></h1> </div> </div> <div id="block-cusm-theme-content" class="block block-system block-system-main-block"> <div class="content"> <article data-history-node-id="54201" about="https://muhc.ca/ombudsman/contact" typeof="schema:WebPage" class="node node--type-page node--view-mode-full clearfix"> <header> <span property="schema:name" content="Contact us" class="rdf-meta hidden"></span> </header> <div class="node__content clearfix"> <div class="field field--name-field-landingp-builder field--type-entity-reference-revisions field--label-hidden field__items"> <div class="field__item"> <div class="paragraph lp-banniere pb-3 pb-md-5 p-0 paragraph--type--landingp-pt-banniere2 paragraph--view-mode--default"> <div class="banniere-img"> <div class="field field--name-field-landingp-img field--type-image field--label-hidden field__item"> <img loading="lazy" src="/sites/default/files/Ombudsman/ombudsman_banner_basic.png" width="1800" height="450" alt="Contact us" typeof="foaf:Image" /> </div> </div> <div class="banniere-txt jumbotron d-flex flex-column justify-content-center left_aligned text-black prop50"> <div class="title"> <h2 class="h1-like text-uppercase">Contact us</h2> </div> </div> </div> </div> <div class="field__item"><style> .wrapper { padding-bottom: 40px; } .divider { position: relative; margin-top: 40px; height: 1px; } .div-transparent:before { content: ""; position: absolute; top: 0; left: 5%; right: 5%; width: 90%; height: 1px; background-image: linear-gradient(to right, transparent, rgb(48,49,51), transparent); } </style> <div class="wrapper"> <div class="divider div-transparent"></div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--column-content-container paragraph--view-mode--default"> <div class="row p-0 m-0 justify-content-center"> <div class="col-lg shadow m-3 p-3 border"> <div class="clearfix text-formatted field field--name-field-body field--type-text-long field--label-hidden field__item"><h4><u>Mailing address</u></h4><p>MUHC Ombudsman Office<br>1650 Cedar Avenue<br>E6.164<br>Montr茅al QC H3G 1A4<br> </p><h4><u>In-person meetings are available by appointment.</u></h4><p> </p></div> </div> <div class="col-lg shadow m-3 p-3 border"> <div class="clearfix text-formatted field field--name-field-body field--type-text-long field--label-hidden field__item"><h4><u>Telephone</u></h4><p><img style="float:left;margin-right:10px;" src="https://muhc.ca/sites/default/files/2024-08/phone-regular-60_0.png" width="35" height="35" loading="lazy"><a href="tel:+15149348306">514-934-8306</a><br> </p><h4><u>Email address</u></h4><p><img style="float:left;margin-right:10px;" src="https://muhc.ca/sites/default/files/email-icon.png" width="35" height="31" loading="lazy"><a href="/cdn-cgi/l/email-protection#93fcfef1e6f7e0fef2fdd3fee6fbf0bdfef0f4faffffbdf0f2" target="_blank" rel="noreferrer noopener"><span lang="FR-CA" xml:lang="FR-CA" data-contrast="none" data-ccp-char><span class="__cf_email__" data-cfemail="8ee1e3ecfbeafde3efe0cee3fbe6eda0e3ede9e7e2e2a0edef">[email protected]</span></span></a><br> </p></div> </div> </div> </div> </div> <div class="field__item"> <div class="paragraph lp-form py-3 py-md-5 container container-large paragraph--type--landingp-pt-form paragraph--view-mode--default" id="formulaire"> <div class="row justify-content-center"> <div class="col-lg-9 mb-3 mb-md-5"> <div class="title"> <h2>Online form</h2> </div> <div class="field field--name-field-landingp-webform field--type-webform field--label-hidden field__item"> <form class="webform-submission-form webform-submission-add-form webform-submission-ombudsman-s-complaint-form-form webform-submission-ombudsman-s-complaint-form-add-form webform-submission-ombudsman-s-complaint-form-paragraph-6347-form webform-submission-ombudsman-s-complaint-form-paragraph-6347-add-form js-webform-details-toggle webform-details-toggle" data-drupal-selector="webform-submission-ombudsman-s-complaint-form-paragraph-6347-add-form" enctype="multipart/form-data" action="/ombudsman/contact" method="post" id="webform-submission-ombudsman-s-complaint-form-paragraph-6347-add-form" accept-charset="UTF-8"> <fieldset data-drupal-selector="edit-site" class="webform-element--title-inline checkboxes--wrapper fieldgroup form-composite webform-composite-visible-title required webform-fieldset--title-inline js-webform-type-checkboxes webform-type-checkboxes js-form-item form-item js-form-wrapper form-wrapper mb-3" id="edit-site--wrapper"> <legend> <span class="fieldset-legend js-form-required form-required">Site</span> </legend> <div class="fieldset-wrapper"> <div id="edit-site" class="js-webform-checkboxes webform-options-display-one-column checkbox"> <div class="js-form-item js-form-type-checkbox checkbox form-check mb-3 js-form-item-site-allan-memorial-ambulatory-care-centre form-item-site-allan-memorial-ambulatory-care-centre"> <input data-drupal-selector="edit-site-allan-memorial-ambulatory-care-centre" type="checkbox" id="edit-site-allan-memorial-ambulatory-care-centre" name="site[Allan Memorial Ambulatory Care Centre]" value="Allan Memorial Ambulatory Care Centre" class="form-checkbox form-check-input"> <label class="form-check-label" for="edit-site-allan-memorial-ambulatory-care-centre"> Allan Memorial Ambulatory Care Centre </label> </div> <div class="js-form-item js-form-type-checkbox checkbox form-check mb-3 js-form-item-site-camille-lefebvre-pavilion-chsld form-item-site-camille-lefebvre-pavilion-chsld"> <input data-drupal-selector="edit-site-camille-lefebvre-pavilion-chsld" type="checkbox" id="edit-site-camille-lefebvre-pavilion-chsld" name="site[Camille Lefebvre Pavilion (CHSLD)]" value="Camille Lefebvre Pavilion (CHSLD)" class="form-checkbox form-check-input"> <label class="form-check-label" for="edit-site-camille-lefebvre-pavilion-chsld"> Camille Lefebvre Pavilion (CHSLD) </label> </div> <div class="js-form-item js-form-type-checkbox checkbox form-check mb-3 js-form-item-site-glen-site-all-adult-services-including-the-royal-victoria-hospital form-item-site-glen-site-all-adult-services-including-the-royal-victoria-hospital"> <input data-drupal-selector="edit-site-glen-site-all-adult-services-including-the-royal-victoria-hospital" type="checkbox" id="edit-site-glen-site-all-adult-services-including-the-royal-victoria-hospital" name="site[Glen site (all adult services, including the Royal Victoria Hospital)]" value="Glen site (all adult services, including the Royal Victoria Hospital)" class="form-checkbox form-check-input"> <label class="form-check-label" for="edit-site-glen-site-all-adult-services-including-the-royal-victoria-hospital"> Glen site (all adult services, including the Royal Victoria Hospital) </label> </div> <div class="js-form-item js-form-type-checkbox checkbox form-check mb-3 js-form-item-site-gilman-ambulatory-care-centre form-item-site-gilman-ambulatory-care-centre"> <input data-drupal-selector="edit-site-gilman-ambulatory-care-centre" type="checkbox" id="edit-site-gilman-ambulatory-care-centre" name="site[Gilman Ambulatory Care Centre]" value="Gilman Ambulatory Care Centre" class="form-checkbox form-check-input"> <label class="form-check-label" for="edit-site-gilman-ambulatory-care-centre"> Gilman Ambulatory Care Centre </label> </div> <div class="js-form-item js-form-type-checkbox checkbox form-check mb-3 js-form-item-site-lachine-hospital form-item-site-lachine-hospital"> <input data-drupal-selector="edit-site-lachine-hospital" type="checkbox" id="edit-site-lachine-hospital" name="site[Lachine Hospital]" value="Lachine Hospital" class="form-checkbox form-check-input"> <label class="form-check-label" for="edit-site-lachine-hospital"> Lachine Hospital </label> </div> <div class="js-form-item js-form-type-checkbox checkbox form-check mb-3 js-form-item-site-montreal-childrens-hospital form-item-site-montreal-childrens-hospital"> <input data-drupal-selector="edit-site-montreal-childrens-hospital" type="checkbox" id="edit-site-montreal-childrens-hospital" name="site[Montreal Children's Hospital]" value="Montreal Children's Hospital" class="form-checkbox form-check-input"> <label class="form-check-label" for="edit-site-montreal-childrens-hospital"> Montreal Children's Hospital </label> </div> <div class="js-form-item js-form-type-checkbox checkbox form-check mb-3 js-form-item-site-montreal-general-hospital form-item-site-montreal-general-hospital"> <input data-drupal-selector="edit-site-montreal-general-hospital" type="checkbox" id="edit-site-montreal-general-hospital" name="site[Montreal General Hospital]" value="Montreal General Hospital" class="form-checkbox form-check-input"> <label class="form-check-label" for="edit-site-montreal-general-hospital"> Montreal General Hospital </label> </div> <div class="js-form-item js-form-type-checkbox checkbox form-check mb-3 js-form-item-site-muhc-adult-ophthalmology-clinic form-item-site-muhc-adult-ophthalmology-clinic"> <input data-drupal-selector="edit-site-muhc-adult-ophthalmology-clinic" type="checkbox" id="edit-site-muhc-adult-ophthalmology-clinic" name="site[MUHC Adult Ophthalmology Clinic]" value="MUHC Adult Ophthalmology Clinic" class="form-checkbox form-check-input"> <label class="form-check-label" for="edit-site-muhc-adult-ophthalmology-clinic"> MUHC Adult Ophthalmology Clinic </label> </div> <div class="js-form-item js-form-type-checkbox checkbox form-check mb-3 js-form-item-site-muhc-reproduction-centre form-item-site-muhc-reproduction-centre"> <input data-drupal-selector="edit-site-muhc-reproduction-centre" type="checkbox" id="edit-site-muhc-reproduction-centre" name="site[MUHC Reproduction Centre]" value="MUHC Reproduction Centre" class="form-checkbox form-check-input"> <label class="form-check-label" for="edit-site-muhc-reproduction-centre"> MUHC Reproduction Centre </label> </div> <div class="js-form-item js-form-type-checkbox checkbox form-check mb-3 js-form-item-site-optilab-muhc-laboratories-hospitals-muhc-st-marys-lakeshore-lasalle form-item-site-optilab-muhc-laboratories-hospitals-muhc-st-marys-lakeshore-lasalle"> <input data-drupal-selector="edit-site-optilab-muhc-laboratories-hospitals-muhc-st-marys-lakeshore-lasalle" type="checkbox" id="edit-site-optilab-muhc-laboratories-hospitals-muhc-st-marys-lakeshore-lasalle" name="site[OPTILAB-MUHC Laboratories (hospitals: MUHC, St. Mary's, Lakeshore, Lasalle)]" value="OPTILAB-MUHC Laboratories (hospitals: MUHC, St. Mary's, Lakeshore, Lasalle)" class="form-checkbox form-check-input"> <label class="form-check-label" for="edit-site-optilab-muhc-laboratories-hospitals-muhc-st-marys-lakeshore-lasalle"> OPTILAB-MUHC Laboratories (hospitals: MUHC, St. Mary's, Lakeshore, Lasalle) </label> </div> <div class="js-form-item js-form-type-checkbox checkbox form-check mb-3 js-form-item-site-the-neuro-montreal-neurological-institute-hospital form-item-site-the-neuro-montreal-neurological-institute-hospital"> <input data-drupal-selector="edit-site-the-neuro-montreal-neurological-institute-hospital" type="checkbox" id="edit-site-the-neuro-montreal-neurological-institute-hospital" name="site[The Neuro (Montreal Neurological Institute-Hospital)]" value="The Neuro (Montreal Neurological Institute-Hospital)" class="form-checkbox form-check-input"> <label class="form-check-label" for="edit-site-the-neuro-montreal-neurological-institute-hospital"> The Neuro (Montreal Neurological Institute-Hospital) </label> </div> </div> </div> </fieldset> <fieldset data-drupal-selector="edit-reason" class="webform-element--title-inline checkboxes--wrapper fieldgroup form-composite webform-composite-visible-title required webform-fieldset--title-inline js-webform-type-checkboxes webform-type-checkboxes js-form-item form-item js-form-wrapper form-wrapper mb-3" id="edit-reason--wrapper"> <legend> <span class="fieldset-legend js-form-required form-required">Reason for contacting us</span> </legend> <div class="fieldset-wrapper"> <div id="edit-reason" class="js-webform-checkboxes webform-options-display-one-column checkbox"> <div class="js-form-item js-form-type-checkbox checkbox form-check mb-3 js-form-item-reason-assistance form-item-reason-assistance"> <input data-drupal-selector="edit-reason-assistance" type="checkbox" id="edit-reason-assistance" name="reason[Assistance]" value="Assistance" class="form-checkbox form-check-input"> <label class="form-check-label" for="edit-reason-assistance"> Assistance </label> </div> <div class="js-form-item js-form-type-checkbox checkbox form-check mb-3 js-form-item-reason-complaint form-item-reason-complaint"> <input data-drupal-selector="edit-reason-complaint" type="checkbox" id="edit-reason-complaint" name="reason[Complaint]" value="Complaint" class="form-checkbox form-check-input"> <label class="form-check-label" for="edit-reason-complaint"> Complaint </label> </div> <div class="js-form-item js-form-type-checkbox checkbox form-check mb-3 js-form-item-reason-i-do-not-know-consultation form-item-reason-i-do-not-know-consultation"> <input data-drupal-selector="edit-reason-i-do-not-know-consultation" type="checkbox" id="edit-reason-i-do-not-know-consultation" name="reason[I do not know (consultation)]" value="I do not know (consultation)" class="form-checkbox form-check-input"> <label class="form-check-label" for="edit-reason-i-do-not-know-consultation"> I do not know (consultation) </label> </div> </div> </div> </fieldset> <fieldset data-drupal-selector="edit-identification" id="edit-identification" class="js-webform-type-fieldset webform-type-fieldset js-form-item form-item js-form-wrapper form-wrapper mb-3"> <legend> <span class="fieldset-legend">Identification</span> </legend> <div class="fieldset-wrapper"> <fieldset data-drupal-selector="edit-patient" id="edit-patient" class="js-webform-type-fieldset webform-type-fieldset js-form-item form-item js-form-wrapper form-wrapper mb-3"> <legend> <span class="fieldset-legend">Patient</span> </legend> <div class="fieldset-wrapper"> <div class="webform-element--title-inline js-form-item js-form-type-textfield form-type-textfield js-form-item-name form-item-name mb-3"> <label for="edit-name" class="js-form-required form-required">Name</label> <input data-drupal-selector="edit-name" type="text" id="edit-name" name="name" value="" size="60" maxlength="255" class="required form-control" required="required" aria-required="true" /> </div> <div class="js-form-item js-form-type-textfield form-type-textfield js-form-item-address form-item-address mb-3"> <label for="edit-address">Address</label> <input data-drupal-selector="edit-address" type="text" id="edit-address" name="address" value="" size="60" maxlength="255" class="form-control" /> </div> <div class="js-form-item js-form-type-tel form-type-tel js-form-item-phone-home form-item-phone-home mb-3"> <label for="edit-phone-home" class="js-form-required form-required">Phone (home)</label> <input data-drupal-selector="edit-phone-home" type="tel" id="edit-phone-home" name="phone_home" value="" size="30" maxlength="128" class="form-tel required form-control" required="required" aria-required="true" /> </div> <div class="js-form-item js-form-type-tel form-type-tel js-form-item-phone-cell form-item-phone-cell mb-3"> <label for="edit-phone-cell">Phone (mobile)</label> <input data-drupal-selector="edit-phone-cell" type="tel" id="edit-phone-cell" name="phone_cell" value="" size="30" maxlength="128" class="form-tel form-control" /> </div> <div class="js-form-item js-form-type-email form-type-email js-form-item-patient-email-address form-item-patient-email-address mb-3"> <label for="edit-patient-email-address">Email address</label> <input data-drupal-selector="edit-patient-email-address" type="email" id="edit-patient-email-address" name="patient_email_address" value="" size="60" maxlength="254" class="form-email form-control" /> </div> <div class="js-form-item js-form-type-textfield form-type-textfield js-form-item-dateof-birth form-item-dateof-birth mb-3"> <label for="edit-dateof-birth" class="js-form-required form-required">Date of birth</label> <input data-drupal-selector="edit-dateof-birth" type="text" id="edit-dateof-birth" name="dateof_birth" value="" size="60" maxlength="255" placeholder="yyyy/mm/dd" class="required form-control" required="required" aria-required="true" /> </div> <div class="js-form-item js-form-type-textfield form-type-textfield js-form-item-dossier-number form-item-dossier-number mb-3"> <label for="edit-dossier-number">Hospital file number</label> <input data-drupal-selector="edit-dossier-number" type="text" id="edit-dossier-number" name="dossier_number" value="" size="60" maxlength="255" class="form-control" /> </div> </div> </fieldset> <fieldset data-drupal-selector="edit-representative" id="edit-representative" class="js-webform-type-fieldset webform-type-fieldset js-form-item form-item js-form-wrapper form-wrapper mb-3"> <legend> <span class="fieldset-legend">Representative</span> </legend> <div class="fieldset-wrapper"> <div class="js-form-item js-form-type-textfield form-type-textfield js-form-item-name-representative form-item-name-representative mb-3"> <label for="edit-name-representative">Name</label> <input data-drupal-selector="edit-name-representative" type="text" id="edit-name-representative" name="name_representative" value="" size="60" maxlength="255" class="form-control" /> </div> <div class="js-form-item js-form-type-textfield form-type-textfield js-form-item-address-rep form-item-address-rep mb-3"> <label for="edit-address-rep">Address</label> <input data-drupal-selector="edit-address-rep" type="text" id="edit-address-rep" name="address_rep" value="" size="60" maxlength="255" class="form-control" /> </div> <div class="js-form-item js-form-type-tel form-type-tel js-form-item-phone-home-rep form-item-phone-home-rep mb-3"> <label for="edit-phone-home-rep">Phone (home)</label> <input data-drupal-selector="edit-phone-home-rep" type="tel" id="edit-phone-home-rep" name="phone_home_rep" value="" size="30" maxlength="128" class="form-tel form-control" /> </div> <div class="js-form-item js-form-type-tel form-type-tel js-form-item-phone-cell-rep form-item-phone-cell-rep mb-3"> <label for="edit-phone-cell-rep">Phone (mobile)</label> <input data-drupal-selector="edit-phone-cell-rep" type="tel" id="edit-phone-cell-rep" name="phone_cell_rep" value="" size="30" maxlength="128" class="form-tel form-control" /> </div> <div class="js-form-item js-form-type-email form-type-email js-form-item-representative-email-address form-item-representative-email-address mb-3"> <label for="edit-representative-email-address">Email address</label> <input data-drupal-selector="edit-representative-email-address" type="email" id="edit-representative-email-address" name="representative_email_address" value="" size="60" maxlength="254" class="form-email form-control" /> </div> <div class="js-form-item js-form-type-textfield form-type-textfield js-form-item-relationship form-item-relationship mb-3"> <label for="edit-relationship">Relationship with the patient (child, spouse, etc.)</label> <input data-drupal-selector="edit-relationship" type="text" id="edit-relationship" name="relationship" value="" size="60" maxlength="255" class="form-control" /> </div> </div> </fieldset> </div> </fieldset> <fieldset data-drupal-selector="edit-complaint-section" id="edit-complaint-section" class="js-webform-type-fieldset webform-type-fieldset js-form-item form-item js-form-wrapper form-wrapper mb-3"> <legend> <span class="fieldset-legend">Complaint section</span> </legend> <div class="fieldset-wrapper"> <div class="js-form-item js-form-type-email form-type-email js-form-item-email-address form-item-email-address mb-3"> <label for="edit-email-address" class="js-form-required form-required">Email address</label> <input data-drupal-selector="edit-email-address" type="email" id="edit-email-address" name="email_address" value="" size="60" maxlength="254" class="form-email required form-control" required="required" aria-required="true" /> </div> <div class="js-form-item js-form-type-textarea form-type-textarea js-form-item-complaint form-item-complaint mb-3"> <label for="edit-complaint" class="js-form-required form-required">Description of your request</label> <div class="form-textarea-wrapper"> <textarea data-drupal-selector="edit-complaint" aria-describedby="edit-complaint--description" id="edit-complaint" name="complaint" rows="5" cols="60" class="form-textarea required form-control resize-vertical" required="required" aria-required="true"></textarea> </div> <small class="description text-muted"> <div id="edit-complaint--description" class="webform-element-description">Please tell us the place (ex.: emergency, clinic, etc.), date and time.</div> </small> </div> <div class="js-form-item js-form-type-textarea form-type-textarea js-form-item-expected-outcome form-item-expected-outcome mb-3"> <label for="edit-expected-outcome" class="js-form-required form-required">Expected outcome</label> <div class="form-textarea-wrapper"> <textarea data-drupal-selector="edit-expected-outcome" id="edit-expected-outcome" name="expected_outcome" rows="5" cols="60" class="form-textarea required form-control resize-vertical" required="required" aria-required="true"></textarea> </div> </div> <div id="ajax-wrapper"> <div class="js-form-item js-form-type-webform-document-file form-type-webform-document-file js-form-item-document form-item-document mb-3"> <label for="edit-document-upload" id="edit-document--label">Additional details</label> <div id="edit-document" class="js-webform-document-file webform-document-file js-form-managed-file form-managed-file"> <div class="webform-managed-file-placeholder webform-document-file-placeholder js-form-wrapper form-wrapper mb-3" data-drupal-selector="edit-document-file-placeholder" id="edit-document-file-placeholder"><h6><em>If you have supporting documentation, please upload it here.</em></h6></div> <input aria-describedby="edit-document--description" data-drupal-selector="edit-document-upload" type="file" id="edit-document-upload" name="files[document]" size="22" class="js-form-file form-file form-control" /> <button class="js-hide button js-form-submit form-submit btn btn-primary" data-drupal-selector="edit-document-upload-button" formnovalidate="formnovalidate" type="submit" id="edit-document-upload-button" name="document_upload_button" value="Upload">Upload</button> <input data-drupal-selector="edit-document-fids" type="hidden" name="document[fids]" class="form-control" /> </div> <small class="description text-muted"> <div id="edit-document--description" class="webform-element-description">One file only.<br />20 MB limit.<br />Allowed types: pdf, doc, docx, jpg, png. </div> </small> </div> </div> <div data-drupal-selector="edit-captcha-documents-ombudsman" class="captcha captcha-type-challenge--recaptcha"> <div class="captcha__element"> <input data-drupal-selector="edit-captcha-sid" type="hidden" name="captcha_sid" value="4274033" class="form-control" /> <input data-drupal-selector="edit-captcha-token" type="hidden" name="captcha_token" value="LaDhC1WQAhCdJBYWZeJOHuSKL71nxekSBx41SKYo7IA" class="form-control" /> <input data-drupal-selector="edit-captcha-response" type="hidden" name="captcha_response" value="" class="form-control" /> <div class="g-recaptcha" data-sitekey="6LfoNAkqAAAAAAGnN9oi4HG87nIRllHpS6VbuFyB" data-theme="light" data-type="image"></div><input data-drupal-selector="edit-captcha-cacheable" type="hidden" name="captcha_cacheable" value="1" class="form-control" /> </div> </div> <fieldset data-drupal-selector="edit-consent-section-complaint" id="edit-consent-section-complaint--wrapper" class="radios--wrapper fieldgroup form-composite webform-composite-visible-title required js-webform-type-radios webform-type-radios js-form-item form-item js-form-wrapper form-wrapper mb-3"> <legend id="edit-consent-section-complaint--wrapper-legend"> <span class="fieldset-legend js-form-required form-required">Consent section</span> </legend> <div class="fieldset-wrapper"> <div id="edit-consent-section-complaint" class="js-webform-radios webform-options-display-one-column radio"> <div class="js-form-item js-form-type-radio radio form-check js-form-item-consent-section-complaint form-item-consent-section-complaint"> <input data-drupal-selector="edit-consent-section-complaint-bi-am-the-patientb-i-consent-to-the-examination-of-my-file-by-a-member-of-the-office-of-the-complaints-commissioner-and-to-the-transmission-of-relevant-information-to-the-persons-concerned-and-consulted" type="radio" id="edit-consent-section-complaint-bi-am-the-patientb-i-consent-to-the-examination-of-my-file-by-a-member-of-the-office-of-the-complaints-commissioner-and-to-the-transmission-of-relevant-information-to-the-persons-concerned-and-consulted" name="consent_section_complaint" value="<b>I am the patient</b>: I consent to the examination of my file by a member of the office of the complaints commissioner and to the transmission of relevant information to the persons concerned and consulted." class="form-radio form-check-input"> <label class="form-check-label" for="edit-consent-section-complaint-bi-am-the-patientb-i-consent-to-the-examination-of-my-file-by-a-member-of-the-office-of-the-complaints-commissioner-and-to-the-transmission-of-relevant-information-to-the-persons-concerned-and-consulted"> <b>I am the patient</b>: I consent to the examination of my file by a member of the Office of the Complaints Commissioner and to the transmission of relevant information to the persons concerned and consulted. </label> </div> <div class="js-form-item js-form-type-radio radio form-check js-form-item-consent-section-complaint form-item-consent-section-complaint"> <input data-drupal-selector="edit-consent-section-complaint-bi-am-a-representativeb-if-you-are-making-a-complaint-on-behalf-of-a-third-party-please-note-that-we-will-need-their-consent-for-their-file-to-be-examined-by-a-member-of-the-complaints" type="radio" id="edit-consent-section-complaint-bi-am-a-representativeb-if-you-are-making-a-complaint-on-behalf-of-a-third-party-please-note-that-we-will-need-their-consent-for-their-file-to-be-examined-by-a-member-of-the-complaints" name="consent_section_complaint" value="<b>I am a representative</b>: if you are making a complaint on behalf of a third party, please note that we will need their consent for their file to be examined by a member of the complaints" class="form-radio form-check-input"> <label class="form-check-label" for="edit-consent-section-complaint-bi-am-a-representativeb-if-you-are-making-a-complaint-on-behalf-of-a-third-party-please-note-that-we-will-need-their-consent-for-their-file-to-be-examined-by-a-member-of-the-complaints"> <b>I am a representative</b>: If you are making a complaint on behalf of a third party, please note that we will need their consent in order for a member of the Office of the Complaints Commissioner to examine their file. </label> </div> </div> </div> </fieldset> </div> </fieldset> <input autocomplete="off" data-drupal-selector="form-pzz6p06gux7wdr6kqvcwcwcxz2o7t-c4ai1ospzfexo" type="hidden" name="form_build_id" value="form-pZz6p06Gux7wdR6KQVCwcwCXZ2o7t_c4Ai1oSpZfexo" class="form-control" /> <input data-drupal-selector="edit-webform-submission-ombudsman-s-complaint-form-paragraph-6347-add-form" type="hidden" name="form_id" value="webform_submission_ombudsman_s_complaint_form_paragraph_6347_add_form" class="form-control" /> <div data-drupal-selector="edit-actions" class="form-actions js-form-wrapper form-wrapper mb-3" id="edit-actions"><button class="webform-button--submit button button--primary js-form-submit form-submit btn btn-primary" data-drupal-selector="edit-submit" type="submit" id="edit-submit" name="op" value="Submit">Submit</button> </div> </form> </div> </div> </div> </div> </div> </div> <div class="field field--name-field-img-gallery field--type-image field--label-hidden field__items"> </div> </div> </article> </div> 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