Complaint Resolution Form

Questions?

We are happy to help you fill this out:

Call 800-883-1549
Text (517) 657-5223

Complaint resolution

We want to hear from you. Use this form to share a complaint, concern or compliment about our products or service. We acknowledge complaints within 5 business days and work to resolve them in writing. Sharing a concern will never affect your care or service.

I would like to share a

Complaint Concern Compliment

Patient information

Patient first name

Patient last name

Patient date of birth

Phone number

Email address (optional)

Are you the patient?

Yes No

If not, your name and relationship to the patient

Tell us what happened

What is this about? (check all that apply)

Product or equipment

Delivery or shipping

Billing or insurance

Staff or customer service

Fitting or instructions

Privacy concern

Other

Date it happened (if known)

Product or order involved (if any)

Please describe what happened

What would you like us to do to resolve it?

Photos or documents (optional)

Add file

Please upload a file

How should we contact you?

Phone Email Mail

Best time to reach you

Other ways to reach us

Midwest Compression LLC, Attn: Compliance Officer – Wendy Kusler, 8988 D Avenue, Richland, MI 49083. Phone 800-883-1549 · Fax 800-886-4201.

Additional reporting numbers:

Medicare: 1-800-MEDICARE (1-800-633-4227)
Community Health Accreditation Partner (CHAP): 1-800-656-9656
Office of Inspector General (OIG): 1-800-447-8477
Michigan Board of Pharmacy – Wholesale License: 517-241-0199

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