Boston Children's Hospital Ombuds Office Visit Request Form
Visit Request Form
Request an appointment with the Ombuds using this secure and confidential form. Alternatively, call us on (617) 355-2865. Please note, it may take a day or two for us to reach out.
Do you work for or at Boston Children’s Hospital?
Yes No
Thank you for contacting the Boston Children’s Ombuds Office. Our office is an internal resource for staff. If you are not a Boston Children’s Hospital employee, please contact Patient Relations at (617) 355-7673 or visit the Patient Relations web site for more information.
Name
Non-US phone number
Personal cell phone or non-work number
Confirm Phone Number
When should we call you back?
(we will try our best to reach you at your preferred time)
Okay to leave voicemail?
Yes No
How do you prefer to meet with us?
Your comfort and ability to fully express yourself is important to us. What should we know or have in place to ensure that? (i.e., interpreting services, closed-captioning, no overhead lighting, an ombuds with a certain gender expression)