Submit Feedback - Portage Path Behavioral Health

Feedback Form

Name

This field is for validation purposes and should be left unchanged.

Name(Required)

Address(Required)

Phone Number(Required)

Email Address

Provider Name/s

Clinic Locations Applicable(Required)

Akron (Main)

North Summit (Cuyahoga Falls)

Barberton

Psychiatric Emergency Services (PES)

Please describe your concern in as much detail as possible, including examples if applicable.(Required)

Please describe the action you would like to see taken in response to your concern.

Authorization(Required)

By checking this box, I certify that the information shared is factual and authorize this information to be shared with Portage Path Quality Improvement staff for resolution.