Grievances Complete the form below to submit your grievances Please provide your contact informationFirst Name *Last Name *Phone *Email Address *Date of Birth *Address *Can we leave a voicemail? *YesNoBest time to reach you? *MorningAfternoonEveningCurrent Program Enrollment *PsychotherapyIntensive Outpatient Program (IOP)Ketamine Assisted Psychotherapy (KAP)Psychiatry (Medication Support Services)Psychological TestingDate of Incident *Time of Incident (Approximate if needed)Name of person(s) involvedPlease describe the incident or provide your concerns/suggestions in as much detail as possible *By signing my name below, I attest that all the responses I have provided above are true *Send Message
