Complaint Form

Fill out the form below to submit your feedback/concern/complaint.
complaint form

You may file this complaint ANONYMOUSLY, by NOT providing us your name and address. Skip to name and address if you wish to remain anonymous. If you remain anonymous, Z.N.D. RESIDENTIAL, INC. will not be able to contact you to obtain additional information or notify you of the results of the complaint investigation.

Section I Complainant Information

Complete only if you wish to receive our acknowledgment and notification letters with the results of the complaint investigation.

NOTE: All person-identifiable information is confidential.

Section II Facility Information

Section III Program Participant Information

Is the Program Participant still in the facility?

Additional Name(s):

Is the Program Participant still in the facility?

Section IV Alleged Wrongdoer(s) Information - if applicable or known

Additional Name(s)/Title:

Section V Narrative Description: