Client Grievance Process & Reporting Form

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Voices for Children seeks to treat all clients with dignity, fairness, respect, and professionalism, and to strive for excellence in providing services to clients. Voices for Children's policy provides clients, and their families or legal guardians, with the opportunity to express any issues or grievance related to the quality of services provided. If you feel you have been treated unfairly, unprofessionally, or feel that your rights have been breached, please complete the form below to inform Voices for Children's staff and leadership.

The following options are available to you in the event of any service issues/conflict:
• If you are dissatisfied with Voices for Children's services, you can discuss the issue directly with your provider.
• If you are not satisfied with the solution reached after speaking with your provider about your concerns, if you feel that you have not been heard, or if you are not comfortable talking directly with your provider, you can:
1. Contact our Programs Director, and Compliance Officer, Krystal McCoy directly at krystal@voicesforcac.org, (989) 723-5877 ext.220.
2. Complete this form below to file a formal grievance. This grievance will be reviewed by our Programs Director, and Compliance Officer Krystal McCoy, krystal@voicesforcac.org (989) 723-5877 ext.220. You may remain anonymous, or include your contact information to receive follow up on what actions are taken to resolve the issue or complaint.
3. Write and submit a written version of this document by submitting to our dropbox located in the family room at either the Shiawassee or Genesee County locations, or by mail to 1216 W Main St. Owosso, MI 48867. This form can be accessed on our website, or in-person during your appointment. Ask a staff person for a form if needed.

No individual, organization, or agency, may discharge or retaliate in any manner against any person that has filed a complaint or grievance.

Please select the statement that most closely describes the current conflict, issue, or incident. *

I feel that I have been discriminated against, by staff, or by service policy, based on my race, citizenship/status, color, religion, sex, gender, national origin, age, orientation/ attraction, disability, political affiliation, or beliefs.

This issue is not related to discrimination, but I feel that I have not been treated with dignity, fairness, respect, and/ or professionalism

Client information

Your name is optional if you prefer to remain anonymous you may. A name and method of contact is required for Voices for Children to follow-up with you on action taken to resolve the conflict or issue.

Name

Phone Number

Presenting issue, complaint, or conflict.

Please take a moment to provide feedback to Voices for Children staff and leadership on any situation you encountered where you felt you have been treated unfairly, with unprofessionalism, or feel that your rights have been breached in any way during your experience with Voices for Children's services.

Is this regarding an interaction with a staff member of Voices for Children?

Yes

I'm not sure

Clear selection

If yes, who is (are) the staff person(s) involved?

Is this regarding a policy or practice of Voices for Children?

Yes

I'm not sure

Clear selection

When did this incident happen?

YYYY

Tell us about what has happened, and how it impacted you.

What do you believe would best resolve the situation or conflict, for yourself, or for others?

Submit

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