Name Best Contact Number :  

Is this form being completed on behalf of the client? 

f yes, please include the name of the person completing the form and their relationship to the client.
Name : Relationship :  

Please explain your complaint or concern as fully as you can. Please use more paper if necessary.  

What action would you like to see taken to address your concerns? Please use more paper if necessary.  

Signing this form is an agreement for our staff to contact you. Someone will reach out within five (5) business days to address your concerns

Leave this empty:

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Options Counseling & Family Services
Signature Certificate
Document name: GRIEVANCE FORM
lock iconUnique Document ID: fe8f0fcfe17b389f4cc0034dfcf253207ca67b55
Timestamp Audit
May 18, 2020 11:38 am PDTGRIEVANCE FORM Uploaded by Adam Falk - IP
May 18, 2020 11:58 am PDTOptions Records - added by Adam Falk - as a CC'd Recipient Ip: