Feedback and Grievance Form | Alcohol Rehab Colorado – Help for Drug & Alcohol Addiction

In order to effectively address your feedback or concerns, we find it helpful to have all questions answered as thoroughly as possible. If you are uncomfortable submitting information on this page, please contact us by telephone at 303-412-3696 to submit your feedback. Thank you for taking the time to participate in our Feedback and Grievance System!

Please identify the program or location this feedback concerns:

Please describe your feedback or concern:

If reporting a problem, what do you suggest as a solution?:

If it is acceptable to contact you, what method do you prefer?:

Phone

Mail

I don't want to be contacted

Is it acceptable for Arapahoe House to leave a message (identifying who we are and why we are calling) on your voice mail, email, or with a person answering the phone? (Check all that apply.):

E-mail - Yes

Phone - Yes

Person - Yes

In order to contact you and effectively address your feedback, we find it very helpful to have your name and contact information; however, providing this information is optional.

Your full name (first, last):

Your Arapahoe House Client ID#:

Your email address:

Your daytime phone number:

Your mailing address:

I am:

Attempting to enter treatment at Arapahoe House (AH)

A current or past client of AH

Family member/friend of someone who is/was a client at AH

Family member/friend of someone who is/was seeking services at AH

Representative of an agency referring someone into services at AH

Other (please describe below)

I am (if you selected "other" above):

If this feedback concerns a client or someone seeking treatment, is the individual an:

Adolescent (Younger than 18 years)

Adult (18 years of age or older)

Unknown

Not applicable

If you are reporting on behalf of another Arapahoe House client having their name would be very helpful to us; however, disclosing this person's name is optional.

Client first name:

Client last name:

Client's AH ID (if known):

Get Help: 303.657.3700

Could you or someone you know have a problem with drugs or alcohol? Call 303.657.3700 or e-mail info@ahinc.org for help. Phone lines are open Mon - Sat, 8 a.m. to 7 p.m. (TTY: 303.412.3636, Video Phone: 720.235.0946)

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Winter 2011 Edition

News of Substance

Arapahoe House - 8801 Lipan Street - Thornton, Colorado (CO) 80260 - 303.657.3700 (TTY: 303.412.3636) info@ahinc.org Sitemap