We are sorry to hear that your experience with Hanger Clinic did not meet your expectations and appreciate you letting us know. Please fill out the information below and you will be contacted by the appropriate management team member to discuss as soon as possible.

Concern Details:

Please let us know the category of your main concern: *

Please select the detail(s) of your concern: *

What type of service is your concern regarding: *

Were scans, molds or measurements taken? *

Please provide details of your concern: *

Please attach any relevant documentation: (if necessary)

Patient Details:

Are you the patient or an individual representing the patient: *

I am the patient

Individual representing the patient

How are you affiliated with the patient? *

Your full name: *

Patient Full Name: *

Patient DOB:
(MM/DD/YYYY) * +

Phone Number: *

Clinic Details:

Clinic Location
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Device Delay	Customer Service/Staff Demeanor	Clinical Care / Device Satisfaction	Billing/Insurance
Other

Compassion / friendliness of office staff	Helpfulness of office staff
Ease of setting appointment	Office Efficiency
Telephone experience	Wait Time in Office
Follow up communications	Facility location
Facility access	Education on financial responsibility
Insurance processing	Billing service issues
Product Pricing	Timeliness of Refund
Confidence in clinician's skills	Device satisfaction/usefulness
Education on device options	Compassion / friendliness of clinician
Turnaround time of device	Valuable/Quality Time with Clinician