If you believe
that one of your rights have been violated, you
(or someone on your behalf) may use this form
to make a complaint. A Rights Officer/Advisor
will review the complaint and may conduct an
You can reach the Office of Recipient Rights at 1-800-281-0481.
The form is available now in Microsoft Word and Adobe Acrobat (PDF). You will
need Adobe Acrobat Reader to be able to view
and print this form. The PDF format can
only be printed and filled out by hand.
The Microsoft Word format can be saved to your
hard drive or diskette, filled out on your
computer, and then printed out and mailed.
Rights When Receiving Mental Health Services
Recipient Rights Advisory/Appeals Committee
Recipient Rights Advisory/Appeals Committee - Application
Rights Complaint Form - Microsoft Word Format
Rights Complaint Form - PDF Format