Client Complaint/ Grievance Form
Flourishing Minds Wellness Center (FMWC) wants to provide you with the best services
possible. We encourage you to communicate your thoughts about our programs and
services. This form explains the procedures for communicating with our staff in the
event that you have a complaint. It allows you to share your feedback so we can work
toward a fair resolution. All complaints will be reviewed promptly and handled with
confidentiality and professionalism. If you wish, you may submit this form anonymously.
You will in no way be subject to reprisal, including denial or termination of services, loss
of privileges, or loss of services as a result of filing a grievance.
You (your guardian, or other representative) are encouraged to try and communicate
any concerns you may have directly with your provider. If you are unable (or unwilling)
to do so, you may request a meeting with the individual’s supervisor or another FMWC
representative, using the attached form.
If you are not satisfied with the outcome of your grievance, you have the right to appeal
the decision. To submit an appeal or speak with a program supervisor or CEO, please
contact our administrative office directly.
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