Feedback

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Next Steps: Sync an Email Add-On

To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.

Your Information

Your Name(Required)

First Last

I am:(Required)

A resident

A family member or friend of a resident

A visitor or member of the public

A staff member

A volunteer

*Select the option that best describes you.

Resident Name

First Last

Contact Information

We would love to chat with you. How can we get in touch?

Daytime Phone(Required)

Alternate Phone Number(Required)

Email(Required)

Please note that email is not a secure medium and the privacy of your information cannot be ensured. In providing your email address, you hereby accept and understand the inherent risk of transmitting your personal information through an unsecured medium.

Geographic Area

Name of Site(Required)

Type of Feedback

Select the type of feedback you are sending(Required)

Compliment

Suggestion for improvement

Concern

Your Comments/Questions(Required)

Personal information collected will only be use for the purpose of tracking, follow up, communications, and trending regarding your experience concern. Information is collected pursuant to the Personal Information Protection Act (Alberta (PIPA)) for the purpose of administering Covenant Living's resident feedback program. For more information, or if you have questions or concerns about the collection, use, or disclosure of your information, please contact Covenant Living privacy at privacy@covenantcare.ca

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