{% extends "layouts/public_base.html" %} {% load i18n %} {% block title %}{% trans "Submit a Complaint" %}{% endblock %} {% block extra_css %} {% endblock %} {% block content %}

{% trans "About This Form" %}

{% trans "Use this form to submit a complaint about your experience at one of our hospitals. We will review your complaint and get back to you as soon as possible." %}

{% csrf_token %}

{% trans "Contact Information" %}

{% trans "Please provide your full name." %}
{% trans "We will use this to contact you about your complaint." %}
{% trans "We may contact you by phone if needed." %}

{% trans "Complaint Details" %}

{% trans "Select the category that best describes your complaint." %}

{% trans "Response Time:" %} {% trans "We typically respond to complaints within 24-48 hours depending on severity." %}

{% endblock %} {% block extra_js %} {% endblock %}