Langdon Prairie Health - Compliance Form

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Compliance Form

AT LPH, our mission is to provide our patients with the highest quality care. If your expectations are not met, please first discuss this with your provider and care team.

To report any quality or compliance issues, please complete our Compliance Form below. The form can be anonymous, or you can provide your contact information if you would like to be contacted about your experience.

Date of Incident:

Time of Incident:

Location of Incident:

Description of Incident:

Please contact me to discuss the incident:

Full Name:

Phone Number

Enter the code shown:

909 2nd St., Langdon, ND 58249 | (701) 256-6100

Compliance Form

Quality of Care and Compliance Concerns