Rights Complaint Form

My therapist. She helps me with my shame and guilt for my mental [health] issues. Does not judge me and helps me to be more positive about the pr...
-Gladwin County

Online Recipient Rights Complaint Form
Complainant's Name*
Recipient's Name
(if different from complainant)
Phone Number*
Address
Where did the alleged violation happen?*
When did it happen?*
(Date and time)
What right was violated?
Describe what happened*
What do you want to have happen in order to correct the problem?*


*Denotes required information.

CMHCM will not sell, disseminate, disclose, trade, transmit, transfer,
share, lease or rent any personally identifiable information to any third
party not specifically authorized by you to receive your information.

My therapist. She helps me with my shame and guilt for my mental [health] issues. Does not judge me and helps me to be more positive about the pr...
-Gladwin County
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