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Complaints and Concerns Submission Form

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Mediplan Complaints and Concerns Submission Form

Date of Incident
Relationship with Mediplan :
EnrolleeProviderClient (Company)Other
Organization Name :- *
HMO ID (Policy ID):
Last Name : *
First Name: *
Telephone No: *
Email Address: *
Submission type: *If you are an enrollee, company or provider please choose self
SelfMediplan internal submission
Mediplan Staff Name :Only required for Mediplan Internal Submissions
Details of Complaint or Concern :

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ABOUT US

MEDIPLAN Healthcare Limited is a Health Maintenance Organization incorporated in May 2000 in Nigeria to carry on the business of providing healthcare services to corporate organizations and members of the public, under a prepaid arrangement, utilizing a network of primary, secondary and specialist healthcare providers nationwide.

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Capital Building, 2nd & 3rd Floors, 332, Ikorodu Road, Idi - Iroko Bus-stop, Maryland, Lagos - Nigeria

E-mail: mediplan@mediplanhealthcare.com Website: www.mediplanhealthcare.com
Tel:
08159394379, 08159394380,
08159394375, 08159394377,
08150869573, 08159394352,
08159394356, 08159394358,
08159093814, 08159093813

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