File a Grievance

About you

First name*Last name*Phone numberEmail address*

Your relationship to the provider*I claim direct, first-person knowledge related to this grievance*

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About the provider

Provider name*Facility against whom the grievance is being filedStreet address

CityZIP codePrimary contactProvider phone

The grievance

Alleged non-compliance with NARR Core PrinciplesSelect all that applyNature of the grievance*Provide a detailed narrativeSupporting documentation

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Authorization

In filing this grievance, I understand that it may be necessary for FARR to disclose information pursuant to this grievance to the subject Provider as well as to external agencies including, but not limited to the Department of Children & Families — Substance Abuse Licensure Division, the Florida Attorney General's Office of Consumer Protection, the Florida Department of Law Enforcement, local law enforcement agencies, and local code enforcement agencies. For this reason, FARR can make no warranty that it will protect the source of this information. However, an attempt is made to withhold disclosure of the source to the extent that is reasonably possible. I authorize unrestricted use of the information filed in this grievance by the Florida Association of Recovery Residences (FARR) to act as it deems prudent and necessary in accordance with the published FARR Compliance Audit Protocol. Please do not include any personal identifying information or protected health information about any individual.

I certify that the above information is entirely accurate to the best of my knowledge.

File a grievance

About you

About the provider

The grievance

Authorization