{"id":15184,"date":"2016-12-14T14:15:18","date_gmt":"2016-12-14T19:15:18","guid":{"rendered":"http:\/\/52.229.127.56\/?page_id=15184\/"},"modified":"2022-11-01T12:34:41","modified_gmt":"2022-11-01T16:34:41","slug":"contact-patient-relations","status":"publish","type":"page","link":"https:\/\/www.ottawahospital.on.ca\/en\/patients-visitors\/patient-relations\/contact-patient-relations\/","title":{"rendered":"Contact Patient Relations"},"content":{"rendered":"<p>Patients and family members can submit their feedback electronically using the form below. After you click submit, a <strong>green box<\/strong> with confirmation will appear at the bottom of the form indicating it has been sent.<\/p>\n<p>I would like to share my experience or provide general feedback about the hospital<\/p>\n\n\n<div class=\"wp-block-contact-form-7-contact-form-selector\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f42526-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"42526\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/15184#wpcf7-f42526-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"42526\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f42526-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_extcf7_conditional_options\" value=\"{&quot;form_id&quot;:42526,&quot;conditions&quot;:[]}\" \/><input type=\"hidden\" name=\"_extcf7_redirect_options\" value=\"{&quot;form_id&quot;:42526,&quot;redirect_options&quot;:&quot;&quot;}\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p><label> Name of the patient: (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"patient-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"patient-name\" \/><\/span> <\/label>\n<\/p>\n<p><label>Date of birth of the patient (yyyy-mm-dd): (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-823\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"date-823\" \/><\/span><\/label>\n<\/p>\n<p><label> Your name (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span><\/label>\n<\/p>\n<p><label> Your relationship to patient: (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"yourrelationshiptopatient\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"yourrelationshiptopatient\" \/><\/span><\/label>\n<\/p>\n<p><label>Your phone number: (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-147\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-147\" \/><\/span><\/label>\n<\/p>\n<p><label>Your email address: (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email-478\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email-478\" \/><\/span><\/label>\n<\/p>\n<p><label>Hospital campus: (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-345\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-345\"><option value=\"General\">General<\/option><option value=\"Civic\">Civic<\/option><option value=\"Riverside\">Riverside<\/option><option value=\"Other\">Other<\/option><option value=\"Unknown\">Unknown<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label>Primary reason for email: (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"primaryreason\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"primaryreason\"><option value=\"Compliment\">Compliment<\/option><option value=\"Concern\">Concern<\/option><option value=\"Both\">Both<\/option><option value=\"Accessibility\">Accessibility<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label> Additional comments:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><em>The Ottawa Hospital will respect your privacy and remove your name and contact details if posting your feedback to the website. <\/em>\n<\/p>\n<p class=\"margintop5\"><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/><a target=\"_blank\" href=\"\/en\/patients-visitors\/privacy\/disclaimer-privacy-statement\/\">Privacy Policy<\/a>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Patients and family members can submit their feedback electronically using the form below. After you click submit, a green box with confirmation will appear at the bottom of the form indicating it has been sent. I would like to share my experience or provide general feedback about the hospital<\/p>\n","protected":false},"author":25,"featured_media":0,"parent":254,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_mc_calendar":[],"footnotes":""},"class_list":["post-15184","page","type-page","status-publish","hentry"],"acf":[],"wps_subtitle":"","_links":{"self":[{"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/pages\/15184","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/users\/25"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/comments?post=15184"}],"version-history":[{"count":0,"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/pages\/15184\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/pages\/254"}],"wp:attachment":[{"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/media?parent=15184"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}