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Accessibility for Ontarians with Disabilities Act (AODA)

Customer Service Feedback Form

Thank you for visiting Bayshore Home Health. We value all of our customers and strive to meet everyone’s needs. We recognize that receiving feedback provides a valuable opportunity to learn and improve.

Date of Visit (DD/MM/YYYY)

Did we respond to your customer service needs?
 Yes No
If No, please explain

Was our customer service provided to you in an accessible manner?
 Yes No
If No, please explain

Optional information – complete only if you wish to be contacted.

Preferred contact method:

Telephone

Email

Mailing Address

Name:

Address:

City:

Postal Code: