My Concern Is
  • Afraid
  • Bad Help
  • Bad Photos
  • Bad Touching
  • Bad Words
  • Can my Provider do this?
  • Can my Worker do this?
  • Food is Poor
  • My Communications
  • My Information
  • My Needs
  • My Safety
  • My Wants
  • Not What I Want
  • Physical Access is Poor
  • Provider Attitude
  • Provider Stopping Me
  • Provider Upsets Me
  • Scared
  • Too Friendly
  • Too Much Money
  • Too Pushy
  • Worker Attitude
  • Worker Stopping Me
  • Worker Upsets Me
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If your Provider is not meeting the relevant Code of Conduct or the Provider’s Standards use this form.

My Concern Is

Communication with me is POOR
My information is NOT CORRECT
They ignore what I SAY
They ignore what I WANT
My help IS BAD
My help is NOT WHAT I WANT
My Food is POOR
Physical Access is POOR
I CANNOT TALK to my worker about this
I CANNOT TALK to my provider about this
They are TOO PUSHY
They are asking for TOO MUCH MONEY
I am BEING STOPPED from doing things
My provider is STOPPING ME
My Worker has a POOR ATTITUDE
My Provider has a POOR ATTITUDE
My worker is being TOO FRIENDLY
I am worried about BAD TOUCHING
I am worried about BAD PHOTOS
I am worried about BAD WORDS
CAN MY worker do this?
CAN MY provider do this?
I am AFRAID
My Safety
I am SCARED