Complaints Resolution Form

To file a complaint, please complete the form below and click the button at the bottom of this form. Once you click send, your complaint will be submitted to CLBC’s Manager of Quality Assurance. We ensure that your personal information will be protected and remain confidential.

Information About The Person Initiating The Complaint

First Name (required)

Last Name (required)

Mailing Address (required)

City (required)

Postal Code (required)

Telephone with Area Code (required)

Email Address (required)

Contact Method Preferences
EmailTelephoneIn Writing

Details About the Complaint

Are you making this complaint for yourself or are you making this complaint for someone else?
For myselfFor someone else

If the complaint is being made for someone else please give his or her full name:

What is your relationship to this person? (Parent, Brother, Cousin, Friend…)

Is this person aware that you are making a complaint on their behalf?
YesNo

Is this person aware that you are making a complaint on their behalf?
YesNo

Have you spoken to someone at CLBC about your complaint?
YesNo

If you have, please say who you have spoken to.

Complaint Details - Tell us your complaint.

What do you think should happen as a result of your complaint? Please describe what you think the outcome could be.

CLBC is committed to improving its complaints process for individuals and families. An independent firm, the Mustel Research Group, has been hired to ask the individual who made the complaint for feedback about the process. Mustel Research Group will be contacting the person after the complaint has been resolved. Do you give permission for Mustel Research Group to call you and ask about your experience with the complaints process, after it has been resolved?
YesNo

Thank you in advance for your consideration.

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