Client Grievance /
Formal Complaint Form

Clients may use this form to submit a formal grievance or complaint in response to the services they received from Bethany. Clients are encouraged to speak with a supervisor if they have concerns and would like them addressed before submitting a formal grievance.

Grievance Form Policy - English

Grievance Form Policy - Spanish

Grievance Form Policy - Creole

Grievance Form Policy - Pashto

Grievance Form Policy - Portuguese

Grievance Form Policy - Dari

First Name

Last Name

Street Address

Street Address Line 2

City

State

Postal Code

Email

Phone

Location of Bethany Office

Program

Please provide a brief summary of your grievance/complaint

Describe how you would like for your grievance/complaint to be addressed

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