Maryland Wellness Complaint/Grievance Form

Maryland Wellness Complaint/Grievance Form
At Maryland Wellness, we are committed to providing quality services and ensuring that all clients, families, and community members feel heard and respected. If you have a complaint regarding our services, policies, or practices, please complete this form and hit submit.

Our Client Advocate or designated staff will respond to all submissions within three business days. If you need immediate assistance, please call (410) 314-1030 or email quality@mdwellness.org.

You may also file a complaint with the U.S. Department of Health and Human Services (DHHS). You can do this instead of or in addition to filing your complaints with Maryland Wellness. To file a complaint with DHHS, send your complaint to:

200 Independence Avenue, S.W., Room 509F HHH Building, Washington, D.C. 20201
Or email: OCRComplaint@hhs.gov
Client Name*

First NameLast Name
Name of Person Completing this Form (if not the client)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

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Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Please clearly describe your complaint. Include important details like dates, places, names of people involved, and anything that has been done to try to fix the problem. *
We understand this may have been difficult for you. Please share what outcome you’re hoping for.*
Signature of person completing form*

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Date*

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Date
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