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
