Department of Human Services Complaint Form

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Please submit the form below. Or download the form and mail it in or submit it in person at any one of the Human Services locations.

The Complaint Coordinator or another staff member will contact you within 2 business days of receiving this form.

Attn: Complaint Coordinator

Your Name

Your Email

Phone

Address

City

Zip

Preferred contact method

Date of Birth

Your role

What type of complaint are you filing today?*

Case Complaint

Civil Rights Complaint

Please provide any case number or other id number to help route your complaint:

Please describe your complaint, providing the names of the employee or employees involved (if known).

Please provide any additional information here if needed:

What do you want the Department to do in response to the complaint?

What have you done to resolve the issue so far?

Per the Americans with Disabilities Act (ADA), Larimer County will provide reasonable accommodation to qualified individuals with a disability who need assistance. Services can be arranged with at least seven business days notice. Please email hs-info@co.larimer.co.us. Walk-in requests for auxiliary aids and services will be honored to the extent possible but may be unavailable if advance notice is not provided.

Department of Human Services Complaint Form

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