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CMHA-CT Complaints Form
We care about what you think!
We welcome comments from clients, families, visitors, other service providers, and members of the public. Please fill out the areas below:
1.
Please identify yourself as one of the following:
Client
Family Member/Friend/Caregiver
Substitute Decision Maker
External Health Professional/Agency
Other (please specify)
2.
Have you spoken to staff about your complaint?
Yes
No
3.
Please describe your complaint:
4.
Do you have any suggestions that would help us resolve your complaint?
If you would like a response, please fill out the following:
5.
Your Full Name:
6.
Program (if applicable):
7.
Phone Number:
8.
Can a message be left at this number?
Yes
No
9.
Email Address:
10.
Preferred method of contact:
Phone
Email