Home / Grievance Form

Grievance Form

Home / Grievance Form

Grievance Form

We’re a team of experienced professionals dedicated to your child’s success.

Client Name *

First

Last

Person submitting grievance *

First

Last

Relationship to client *

Date of submission *

Date

Time

Indicate MAC Program(s) where concern occured *

Please describe the concern (for example: include topic, personnel and date(s) of origin for concern) *

Please indicate previous attempts to resolve your concern (for example: who you shared the concern with, date of outreach, the response received and any change in expressed concern). *

Additional Information

Please provide any supporting images or documentation

Click or drag a file to this area to upload.

Please indicate your preferred modality of communication *

Phone
Email
In person

Phone *

Email *

Confirm Email

Thank you for your contact and informing MAC of your concern. We are invested in providing the most effective services as well as ensuring superb customer service for your loved one and family. A member of Leadership will reach out to discuss and resolve this matter.

Grievance Form

Grievance Form

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