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Complaint Form/Licensed Substance Use Disorder and/or Problem Gambling Treatment ProgramPlease Print or Type PERSON REGISTERING COMPLAINT Provide all information Name: Home Phone: Address: City/State/Zip
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How to fill out contact us - pa

01
Open the contact us page on the website
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Fill in your name in the appropriate field
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Enter your email address
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Contact Us - PA refers to the form or communication process used to reach out to authorities or services in Pennsylvania for inquiries or assistance.
Generally, individuals or entities that have a specific inquiry or need assistance related to Pennsylvania state services are required to file Contact Us - PA.
To fill out Contact Us - PA, individuals should provide their personal information, the nature of their inquiry, and any relevant details to facilitate assistance.
The purpose of Contact Us - PA is to allow residents and businesses to communicate with government agencies in Pennsylvania regarding questions or issues they may have.
The information that must be reported includes the individual's contact details, the subject of the inquiry, and any pertinent background information related to the request.
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