Client Complaint Form (FORM-HR-CC-001)
Please provide detailed information about your concern and how we can assist you.
PART A — FOR OFFICE USE ONLY
Complaint ID
Office use only
Date Received
-
Month
-
Day
Year
Date
Received By
HR Assigned To
PART B — CLIENT INFORMATION
Full Name
*
First Name
Last Name
Client / Matter Number
Preferred Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Best Time to Call
Email Address
*
example@example.com
Preferred Method of Follow-Up
Phone Call
Email
In-Person Meeting
Written Letter
No Follow-Up Needed
PART C — COMPLAINT DETAILS
Date of Incident
*
-
Month
-
Day
Year
Date
Approximate Time of Incident
How Was the Complaint Received?
*
Verbally — In Person
Verbally — By Phone
Email
Written Letter / Mail
Text Message
Online / Other
Who Is This Complaint About?
*
Specific Attorney
Paralegal / Legal Assistant
Administrative Staff
Billing / Accounting
Firm Generally
Other
Name(s) of Individual(s) Involved
PART D — AREAS OF CONCERN
COMMUNICATION
Delayed or no response to calls/emails
Lack of case status updates
Unclear or confusing communication
Information not communicated timely
PROFESSIONAL CONDUCT
Rude or disrespectful behavior
Dismissive or unhelpful attitude
Discriminatory or biased treatment
Breach of confidentiality
LEGAL SERVICES / REPRESENTATION
Missed deadlines or court dates
Errors in legal documents or filings
Lack of preparation for hearings/meetings
Disagreement with legal strategy/advice
BILLING & FEES
Unexpected or excessive charges
Billing statement errors or discrepancies
Fees not explained or agreed upon
Dispute over retainer or invoiced amount
OFFICE / ADMINISTRATIVE
Scheduling or appointment issues
Long wait times
Documents lost or not received
Reception / front desk experience
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Option 1
Option 2
Option 3
PART E — DESCRIPTION OF COMPLAINT
Please describe your complaint in detail. Include what happened, when, where, and who was involved.
*
PART F — DESIRED OUTCOME
What resolution are you seeking?
Apology / Acknowledgment
Staff Corrective Action
Billing Adjustment / Refund
Change in Assigned Attorney
Additional Legal Action
No Specific Request
Additional Comments on Desired Resolution
PART G — SUPPORTING DOCUMENTS
Do you have supporting documents?
Yes — Attached
Yes — Available Upon Request
No
List of Attached Documents
Upload Supporting Documents
Upload a File
Drag and drop files here
Choose a file
Cancel
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PART H — AUTHORIZATION & SIGNATURE
I certify that the information provided is accurate and complete. I authorize Chisolm Trimble & Associates LLC to contact me using the information provided.
E-Signature
*
Date signed
*
-
Month
-
Day
Year
Date
Submit Complaint
Submit Complaint
Submit Complaint
Submit Complaint
Should be Empty: