Relationship to patient
(CLSC, Youth Protection, rehabilitation center, other)
Reason for complaint
Indicate why you are dissatisfied and the reason for your complaint*:
State your expectations in the treatment of this complaint*
I hereby authorize the Local Service-Quality and Complaints Commissioner to divulge this complaint to the Head of the concerned Department, only for its examination. Strict confidentiality will be upheld during the entire length of the examination process.