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Novel Coronavirus - COVID-19: Information for Community Behavioral Health Providers, Consumers, and Families

Grievance Form

When an applicant is denied certification, denied re-certification, or questions the results of the
application review, the applicant may file a grievance. Grievances are reviewed by the CPRS
Advisory Committee. The applicant must submit any grievance within thirty (30) calendar days of
receipt of notice of denial or any other action deemed unjustified.

It is the applicant’s responsibility to ensure that all required documents are submitted and completed as accurately as possible.  Please complete and submit either the online or printable form.

Online Grievance Form

Printable Grievance Form