Mental Health Partners-Complaint/Concern/Compliment Form

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MHP 3-C Form (Complaints - Concerns - Compliments)
Would you like to make a complaint to Mental Health Partners? Do you have a concern that we should know about? Perhaps you would like to offer a compliment to MHP? Use this form to voice your opinion on a matter you feel our organization should know about. We will review each submission and take the appropriate action when necessary. Unless noted otherwise, all information submitted is kept confidential. Complete the form and click 'Submit'. Your information will be delivered to a MHP Representative. Thanks for your input. Complaints, concerns, and compliments may also be called into Customer Services at 1-877-484-2595.
* denotes required fields
* Your Name:
* Phone (Contact) Number:	(Format: 333-222-1234)
Email Address:
* Complaint, Concern, Compliment:

*Some issues may require us to clarify the situation by contacting you for discussion. If necessary, may Mental Health Partners contact you to discuss your issue?	Yes, Mental Health Partners may contact me. No, Mental Health Partners should NOT contact me.

*There are times when we would need to share your personal information with the parties involved in order to rectify the issue. If your issue is deemed as such, may we share your information with the parties involved?	When necessary, Mental Health Partners may share my personal information with other parties involved. Mental Health Partners should keep my personal information confidential! (I recognize that my issue may not be fully resolved without full disclosure of the situation.)

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