Cardiology Practice Complaint Form

Streamline Patient Feedback and Improve Cardiology Care Quality

When running a busy cardiology practice, patient complaints and concerns need to be captured systematically and addressed promptly. Whether it's confusion about test results, unexpected medication side effects, scheduling frustrations, or general care quality issues, having a structured complaint process builds trust and helps you continuously improve.

This Cardiology Practice Complaint Form template gives your practice a professional, compassionate way to collect detailed patient feedback. Instead of relying on phone calls, voicemails, or fragmented emails, you can offer patients a clear, structured form that ensures every concern is documented completely and routed to the right person on your team.

Built for cardiology-specific concerns

This template is designed specifically for cardiology practices and includes fields for:

• Test interpretation concerns – ECG, echocardiogram, stress test, or cardiac catheterization results
• Medication side effects – Beta-blockers, anticoagulants, statins, ACE inhibitors, and other cardiac medications
• Procedure scheduling issues – Delays, cancellations, communication gaps, or wait times
• General care quality – Staff interactions, wait times, communication, billing, or facility concerns

Conditional logic adapts the form based on the complaint type, so patients only see relevant follow-up questions and your team receives properly categorized submissions.

How Paperform helps healthcare practices handle complaints professionally

With Paperform, you can embed this form directly on your patient portal, link it from appointment reminder emails, or share it via SMS after a visit. Submissions are captured securely, and you can use Stepper (stepper.io) to automatically route complaints to the appropriate department—clinical concerns to your nurse manager, scheduling issues to your front desk supervisor, and billing complaints to your admin team.

You can also set up automated acknowledgment emails to reassure patients their complaint has been received and will be reviewed within a specific timeframe, improving patient satisfaction even when issues arise.

HIPAA considerations

While Paperform provides SOC 2 Type II compliance and enterprise-grade security, it is not a HIPAA-compliant solution. For practices that need HIPAA compliance, we recommend configuring this form to avoid collecting protected health information (PHI) directly, or using Paperform in combination with your existing HIPAA-compliant systems for routing and follow-up.

Designed for patient care teams who value feedback

This template is ideal for cardiology practices, cardiac care centers, and cardiovascular clinics that want to demonstrate accountability, gather actionable feedback, and resolve issues before they escalate. By making it easy for patients to voice concerns in a structured way, you show that their experience matters—and you create a clear audit trail for compliance and quality improvement initiatives.