RFS Consumer Grievance / Appeal Form

“Helping families provide missing pieces”

Welcome to the Restoration Family Services, Inc.’s ” RFS Consumer Grievance/ Appeal Form” platform.

 

Please fill in all required fields *:

 

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If for any reason you do not agree with Restoration Family Services, Inc. (RFS, Inc.) policies/procedures and any staff member, you have the right to make a grievance/appeal to Restoration’s clinical staff regarding your concerns.  Please note that under no circumstances should there be any reprisal or negative consequences toward the person filing this grievance/appeal.  RFS, Inc. does request that you complete this form in its entirety.





    Program/Employee Complaint:*


    Please state your complaint, to include names, dates, times, and locations:*


    What would you like us to do to address this issue?


    Legally Responsible Person / Adult Consumer

    Please write your signature in the box below:*

     





    Stand: 04/21/2021

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