Acknowledgement of Client Grievance Policy

First Name(Required)

Last Name(Required)

Phone(Required)

Email(Required)

This is to confirm that I have received the CLIENT GRIEVANCE POLICY maintained at the Neighborhood Counseling Center. I have been informed that this policy outlines the procedures available to clients to file complaints at the Neighborhood Counseling Center pertaining to any dissatisfaction with agency services or any concern related to any experience with this agency.

Full Name (electronic signature)(Required)

If client is under 18, a parent or guardian must sign to provide authorization

Date(Required)

Give us a Call

Send us a Message

Acknowledgement of Client Grievance Policy

Acknowledgement of Client Grievance Policy

Counseling Services

In an Emergency

Opening Hours