{% extends "layouts/public_base.html" %} {% load i18n %} {% block title %}{% trans "Submit a Complaint" %} - PX360{% 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 "Complainant Information" %}

{% trans "Please provide your full name." %}

{% trans "Patient Information" %}

{% trans "Complaint Details" %}

{% trans "Location Selection" %}

{% trans "Select the location where the incident occurred. Start with the general area, then section and subsection if applicable." %}

{% trans "Click to upload files" %}

{% trans "Images, PDF, Word (max 10MB each)" %}

{% endblock %}