Ratings and Reviews Appeal Form

Use this form if you have a concern about a rating or review you have received on your star card. Your request will be reviewed by the Transparency Advisory Committee (TAC) and the comment will be removed until the committee's review is complete. You will be notified via email of the status of your appeal and the committee’s decision to permanently archive (remove) or republish. Our goal is to work with you on resolving any issues and improve the overall patient experience.

Name of Provider:

First Last

Email(Required)

Phone

Date Comment Was Posted:

Rating Received in Comment:

Comment Details (copy and paste comment):

Reason for Appeal:

Do you have any suggestions for ratings and reviews process improvement?

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