64 Client Grievance Form

SOUTHERN MINNESOTA BEHAVIORAL HEALTH CLIENT GRIEVANCE FORM

Name(Required)
MM slash DD slash YYYY
____________________________________________________ Please return form to: Southern Minnesota Behavioral Health 1407 S. State St. New Ulm, MN 56073
Clinical Director / Executive Director Signature
MM slash DD slash YYYY
F:\Common\Agency\Forms\FR0176 Client Grievance Form.doc 10/4/2021

the office closed September 1, 2023.
If you are looking for your medical record, please contact Counseling Services of Southern Minnesota, St. Peter.