Get the free Complaint Intake Form - Oregon.gov

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PUBLIC HEALTH, Health Care Regulation & Quality Improvement. O Box 14450 Portland, OR 97293 Voice 9716730540 FAX 9716730556 TTY 9716730372 http://www.healthoregon.org/hcrqiComplaint Intake Firsthand

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How to fill out complaint intake form

01

Start by obtaining a blank complaint intake form.

02

Read the instructions and requirements carefully before filling out the form.

03

Begin by entering your personal information, such as your name, address, and contact details.

04

Provide a detailed description of the complaint, including the date, time, and location of the incident.

05

Include any supporting documents or evidence, if applicable, such as photographs or witness statements.

06

Clearly state what action you would like to be taken to resolve the complaint.

07

Sign and date the form to indicate your agreement with the information provided.

08

Review the completed form for accuracy and completeness before submitting it.

Who needs complaint intake form?

01

Anyone who wishes to file a complaint against a person, organization, or business needs a complaint intake form.

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What is complaint intake form?

The complaint intake form is a document used to gather information regarding complaints or concerns.

Who is required to file complaint intake form?

Any individual or organization experiencing an issue or concern can file a complaint intake form.

How to fill out complaint intake form?

To fill out a complaint intake form, provide detailed information about the complaint or concern, including dates, locations, and any relevant supporting documentation.

What is the purpose of complaint intake form?

The purpose of the complaint intake form is to streamline the complaint process and ensure all relevant information is captured.

What information must be reported on complaint intake form?

The complainant must report detailed information about the issue, including names, dates, locations, and any supporting evidence.

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