Discrimination Complaint Form

Please note that this form is for reporting discrimination concerns. If your communication relates to another matter, please reach out to Patient Relations:

Care at Home: 978.552.4159 
Lowell General Hospital: 978.937.6458
MelroseWakefield Hospital: 781.979.3021
Tufts Medical Center: 617.636.9590

Your information

First name

Last name

Date of birth

Medical record number

Phone

Email address

Location - Select -Care at HomeLowell General HospitalMelroseWakefield HospitalTufts Medical Center

Describe your discrimination concern:

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Submit

Download the Notice of Non-Discrimination + Accessibility by entity

Tufts Medical Center

Care at Home

Lowell General Hospital

MelroseWakefield Hospital