Complaint Form

Thank you for your submission.
Someone from The Compliance Team will contact you within 48 hours.


File Another Complaint

Date of the Concern:	(MM/DD/YYYY)
Patient For Whom The Complaint Is Being Filed:	First   Last
Patient City/State:	City   State
Name of Person Filing the Complaint (Your Name):	First   Last
Position/Role Within Company (if applicable):
Relationship to Beneficiary:
Contact Phone Number:
Contact Email Address:
Medical Service Clinician Name:
Medical Service Provider Location:	City   State
Summary of the Complaint:
In the text box below, enter the code you see on the right:

©2026The Compliance Team, Inc. P.O. Box 160, 905 Sheble Lane, Suite 102, Spring House, PA 19477

Certified Women's Business Enterprise    

Employee SF Login            Employee OWA Login