You are using an outdated browser. Please upgrade your browser to improve your experience and security.

Employee Benefit Plans

TELUS Health Quality Assurance Review Form

Requestor of Quality Assurance Review

Plan Member's Organization

First Name

Last Name

Number used to call into Care Access Centre (cell phone, landline)

Date and time of call, incident, appointment

Name of TELUS Health representative that individual spoke with (if known – not mandatory)

Nature of the concern/complaint

By completing this form you consent to this information being shared with TELUS Health to complete an internal and confidential Quality Assurance Review. Please indicate below whether you consent to receiving an outreach for any additional scenerios.

Consent can be given or not in any of the variations offered, they are all independent.

Discuss your inquiry

Yes

Schedule or rebook service

Yes

Best phone number to reach you

Best time of day to reach you

Can TELUS Health leave a discreet message?

Yes