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Do you have a concern or complaint?
FORMAL CONCERN OR COMPLAINT FORM
Name
First
Last
Write down your complaint in your own words:
How do you feel we could best take care of the issue to make it right?
What is the best way for us to communicate with you?
*
Please choose one...
Mail
Phone
In Person
Other
Email
Phone
How would you like us to get in touch with you?
Our quality of service analyst Gabrielle Kullman will get back to you about this complaint within 10 working days Monday to Friday this will be in writing and it will describe how we will act on your complaint. If you do not feel that the response is fair or appropriate you may ask to have the matter look into by the agency director. We ask that you make this request within one month 30 days of receiving the written response from the quality of service analyst.
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Formal concern of complaint form