Children's Treatment Network

Complaint Form

First Name:

Last Name:

Address:

City:

Postal Code:

Home Phone:

( ) -

Work / Cell Phone:

( ) -

Email:

Do you need an interpreter? :

YesNo

Please describe your complaint: (provide detail about what happened, time and location, and who was involved)

When is the best time to contact you?:

Is there anything else we need to know:

Note: We will be in touch with you within 7 business days. If you prefer not to write about your complaint, please call 1-866-377-0286.