Comment Form

Piedmont Internal Medicine values the comments and concerns of its patients. We are committed to operate in a manner that is responsive to concerns, promotes patient confidentiality, and delivers the highest quality health care possible. If our staff has fallen short of this goal, we want you to notify us. Please be assured that your complaint will be kept confidential.

If this is a privacy complaint, you will receive a formal response from the corporate Privacy Officer. All other patient comments and concerns will be handled by the Supervisor/Manager of the appropriate department, or if necessary, referred to our Executive Committee for resolution.

Please use the space provided below to describe your comment or complaint. Please be detailed and include the type of infraction or a description of the issue, as well as the date/time the incident or problem occurred (if applicable). It is our intent to use this feedback to address your issue, as well as to improve the healthcare experience of all our patients. Positive feedback and suggestions are appreciated as well.

NOTE: In general, we would like to be notified of your complaint as soon as possible, so we may address it in a timely fashion.

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Form Options

For your convenience, you may print and complete the form, or you may submit the form online.

Printable Form

You may download and complete the form and hand deliver, mail it, fax it, or email it to our office.

• Printable Form

You may hand deliver your completed form in person to the office or mail it to:

Piedmont Internal Medicine
ATTN: Managers
3280 Howell Mill Rd NW, Suite 150
Atlanta, GA 30327

You may also email a copy to CustomerService@pimapc.com, or fax it to 404-352-1175.

Online Form

Or you may use our secure, online form below.

Comment/Concern Form

Patient/Representative Name:
Date:
Phone Number:
Email Address:
Mailing Address: (Street, City, State, Zip Code)
Your Comment/Concern: