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: Question Title * 1. Please identify yourself as one of the following: Client Family Member/Friend/Caregiver Substitute Decision Maker External Health Professional/Agency Other (please specify) Question Title * 2. Have you spoken to staff about your complaint? Yes No Question Title * 3. Please describe your complaint: Question Title * 4. Do you have any suggestions that would help us resolve your complaint? If you would like a response, please fill out the following: Question Title * 5. Your Full Name: Question Title * 6. Program (if applicable): Question Title * 7. Phone Number: Question Title * 8. Can a message be left at this number? Yes No Question Title * 9. Email Address: Question Title * 10. Preferred method of contact: Phone Email Done