GAFC Grievance Form

Advanced Home Care is committed to providing reliable, quality care to all our clients. If you have questions, suggestions or grievances, please complete this form and a member of our care team will follow up with you, directly.

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GAFC Member Name*

Phone Number*

Email Address*

Direct Care Aid Assigned

Name(s) of other involved individuals, if appropriate

Please describe the issue below*

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Disclaimer: By pressing the submit button below, I give Advanced Home Care consent to use automated telephone dialing technology to call and/or use SMS text messages at the phone number provided including a wireless number for telemarking purposes. I understand consent is not a condition of purchase of Advanced Home Care’s services. By pressing submit I also agree to the Advanced Home Care’s Privacy Policy.

Phone

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