Fillable Comment Form Ilanka Community Health Center This form (Native Village of Eyak)

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Comment Form Ilanka Community Health Center This form (Native Village of Eyak)

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Revision: 4.14.2020
Ilanka Community Health Center
705 Second Street – PO Box 2290
Cordova, AK 99574
Ph: 907-424-3622 Fax: 907-424-3275
Comment Form
This form is for general comments/concerns. If you have questions about
medical conditions, treatments, prescriptions, or other health information,
please call us at 424-3622.
Name: _________________________________________________________________________________
Department: Front Desk Clinical Behavioral Health Referrals/Case Management
Financial/Billing Other _________________________________
Comments and/or Concerns: _______________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
YES Please call me at: ___________________ Would you like to be contacted for further resolution:
NO Please do not contact me.
CLICK HERE TO SEND YOUR COMMENT
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Comment Form Ilanka Community Health Center This form (Native Village of Eyak)

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Completed 20 July 2020

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