Complaint form

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Complaint form

Using this form you can file a complaint to the complaints mediator of Mental Health Caribbean. To process your complaint more effectively and efficiently, we ask you to answer as many of the following questions as possible.

Your details

Name*

Address

Telephone

E-mail

Choose your location

Concerns

Concerning

A complaint from myself A complaint on behalf of a client of MHC

Client details (if applicable)

Name*

Address

Telephone

E-mail

Klacht

Date of the occurence:

Complaint concerns:

Treatment Application Diagnosis Implementation of care Aftercare Information Other (please specify)

Description complaint. What happened, where did it happen, who was involved and how did it happen.