Complaints - IHC

First Name*
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Last Name*
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Email*
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Phone Number*
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Postal Address*
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Complaint details

Details of complaint*
Limit of 200 characters
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What outcomes are you seeking?*
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Have you made a report about this to another body?
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Details of previous report including any outcomes*
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Please upload any supporting evidence or documentation here (PDF, JPEG or PNG)
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Date
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By submitting this form you consent to ALHCA proving information to a third party such as the Support Agency to resolve your issue.