Grievance Form

For current Ascend clients, please fill out the form below to submit a grievance. We will respond within three business days.

Fill out the form.

This form was created to help Ascend clients communicate problems and potential solutions regarding Ascend’s services. We take these requests very seriously—please fill out the form and a member of our staff will be in touch with you as soon as possible.

Date(Required)

Grievance Against

Name(Required)

First Last

Statement of Grievance(Required)

Please explain your experience.

Remedy Requested(Required)

Please detail your possible solution.

Signature