Complaint Form
Use this form to submit your complaint. Recipient and/or Caregiver complaints shall be investigated and resolved within 30 days. If a complaint cannot be resolved in 30 days, and explanation shall be given for the delay. Public complaints shall be investigated at our discretion, and referred to the controlling agency as appropriate.
Date of Compaint
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Month
-
Day
Year
Date
Person Filing Compaint
First Name
Last Name
E-mail
Phone Number
Please enter a valid phone number.
Description of Complaint
Submit
Should be Empty:
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