File A Grievance

Our goal is to get you and your loved ones the help they need in the best and most caring way possible.

If you've had a bad experience with Sandhills Center or one of our contracted providers, we want to know about it.

Please use the form below to let us know exactly what happened. After we receive your message, we'll get in touch with you to work out the issue to the best of our ability.

Grievance Form (en Espanol)

Name of Person Submitting the Grievance*

First*

Please enter a First

Last*

Please enter a Last

First and Last Name of Sandhills Center member (if known)

Date of Birth of Sandhills Center Member (if known)

Race/Ethnicity of Sandhills Center Member (if known)

May Sandhills Center contact you?*

Yes

An option must be selected.

May Sandhills Center use your name during the investigation?*

Yes

An option must be selected.

Preferred method of contact:*

Phone

An option must be selected.

Please enter your selected preferred method of contact information.

Phone*

Please enter a Phone

Is the problem with a provider or with Sandhills Center?*

Provider

An option must be selected.

Sandhills Center

An option must be selected.

Provider Name

Provider Location (City, State, Zip)

Date of Incident/Ride (Format MM slash DD slash YYYY)*

Please enter a Date of Incident/Ride (Format MM slash DD slash YYYY)

Description of your grievance/complaint

Your Address (Street Number, Street Name, City, State, Zip Code)

Your Phone Number*

Please enter a Your Phone Number

Residential Type

Funding Source

Today's Date (Format MM slash DD slash YYYY)*

Please enter a Today's Date (Format MM slash DD slash YYYY)