Please complete it to the best of your ability.
Purpose of this form:
This form is for clients of Damien Center who would like to submit a formal grievance regarding the services they have received. You can use this form to report concerns such as:
- Quality of care
- Confidentiality issues
- Violations of policies or procedures
Please note:
- Grievances about other clients or external agencies cannot be addressed through this form.
- Filing a grievance will not affect your services, care frequency, or service quality.
- Damien Center prohibits any retaliation for submitting a grievance.
- You may choose an advocate to support you during the grievance process.
- You can withdraw your grievance at any time.
Other Ways to File a Grievance:
You may also contact our Grievance Liaisons directly:
External Reporting Options:
Pharmacy:
Mental Health and Substance Use Treatment:
Civil rights or health privacy violations:
HIV Care: