Complaints and Concerns Form Your Complaint or Concern Please ask a worker to help you fill out this form if needed. Any C.M.H.A. H.K.P.R. worker can help you, and they will ensure that your complaint or concern is directed to the right supervisor. We will follow up with you within 5 business days of receiving a complaint. Your Name First Last Your Worker's Name First Last Would you like this complaint to go to your worker, or to their supervisor? To your worker To their supervisor Are you a client of C.M.H.A. H.K.P.R., family member, or other?How can we reach you? Phone:Email Date of Complaint - must be mm/dd/yyyy format 1. Please describe your complaint or concern. Include what has happened, and what you think should happen now.2. Please describe if anyone has already tried to help you with this complaint or concern.