Circle of Life / First Nations / Soaring Eagles Complaint Form
Circle of Life/First Nations/Soaring Eagles will make every attempt to process and resolve complaints promptly and efficiently. We will not retaliate or discriminate in any way against a client or employee that submits a complaint or cooperates in the investigation of a complaint. All complaints will be investigated. If you choose to provide your contact information, you will receive written response as soon as possible, but no later than 15 business days after receipt of the complaint.
Date of Complaint
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Month
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Day
Year
Date
Type of Complaint
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Employee Complaint
Client Complaint
HIPAA Complaint
Other
I am a ...
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Client
Employee
Responsible Party (RP)
Other
Your Name (optional)
Your Email (optional)
Your Phone Number (optional)
Date of Incident (if known)
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Month
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Day
Year
Date
Complaint Against (name)
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Description of Complaint
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Submit
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