Quality Improvement Form

All information collected from this form will be kept confidential with the Distress Centre of Ottawa and Region

Please check the appropriate box:
(* all fields are required)

"*" indicates required fields

* Select which services you are concerned about (you may check all boxes):*
Select geographic area:*
DD dash MM dash YYYY
Contact information:
Please enter contact information where you may be reached for follow-up. Our follow-up may include gathering more information to help us properly address your concern or to inform you of measures we are taking to improve the quality of our services as a result of your participation in this process.
*Required information. Feedback form will not be accepted without required information.