a non-profit, comprehensive,
community mental health service

File a Complaint

You can file a complaint about any of the services you have received here if you or someone you know…

• has had their rights as a client infringed, violated or unfairly limited;
• has been abused, neglected or mistreated;
• has been dealt with in an illegal, improper or unjust manner;

To file a complaint, fill out this form and return it to the above address.  If you prefer you can call the above number and ask to leave a message for the complaint investigator.

If you wish to provide a compliment or positive feedback about any of our staff who have been especially helpful, you may fill out this form.  In doing so you allow them to be properly acknowledged for their efforts by the agency.  To record a compliment, complete and return this form to the address listed below.

NAME (Optional): _________________________________________          Phone: _____________

ADDRESS: ___________________________________________________________________

Give a description of the situation (complaint or compliment) to which you are referring.  Attach another piece of paper if necessary.

Please list staff of Monadnock Family Services who may have information about this situation or who were involved in it.

__________________________        _____

Signature                                                Date

Please copy and send this form to: Complaints Officer, Monadnock Family Services, 17 93rd Street, keene, NH 03431