Rutti Counseling & Consultation
Grievance Form
This form is used by RCC to begin investigating grievances or complaints against any of our team members or affiliates. You may complete this form anonymously, knowing that this may impact RCC's ability to do a full investigation or provide a resolution to your concern. The RCC office is committed to a full investigation of all complaints. Please provide as much detail as possible to help with the investigation.
Name
First Name
Last Name
E-mail
example@example.com
Phone Number
-
Area Code
Phone Number
Would you be open to a follow up phone conversation?
*
Yes
No
Reason for filing the grievance
*
Description of event/grievance
*
Supporting documentation
*
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