Recovery House Form
This is a confidential form for people to submit. Please read the Grievance Procedure before submitting complaint.
Email address *
About You
This section is about you. Your name, where you live, and your contact information. All information is required, however, all identifying information is confidential. If an investigation is determined to be relevant, the incident itself will be discussed during the investigation, but no revealing information about you will be shared.
Your Name *
Your answer
Age *
Your answer
Your Address *
Your answer
Phone Number *
Your answer
Preferred method of contact *
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