Complaint & Incident Form

We encourage our clients to inform us of any complaints or incidents that may occur to help us improve our client care services. Please fill out the complaint & incident form as detailed and accurate as possible for best outcomes.

Complaints will be reviewed and responded to within 3 weeks of submission and processed within 6 weeks of review.

Your Information

Title ✱ First Name ✱ Last Name ✱

Birth Date ✱

Phone ✱ Email ✱

Address Country of Residency ✱

Client

Is the petitioner other than the patient? ✱ Yes No

Title ✱ Client First Name ✱ Client Last Name ✱

Client Birth Date ✱

Client Phone ✱ Client Email ✱

Client Address Country of Residency ✱

Complaint

Date of complaint occurrence ✱

Does your complaint concern a specific department? ✱
Yes No

Please specify the department ✱

Does your complaint concern a specific staff member? ✱
Yes No

Please specify the person's name ✱ You can review pictures of our listed staff members here.

Other staff name ✱

The complaint concerns: ✱

Other complaint subject ✱

Complaint description ✱ Please describe the complaint in detail pertaining what happened, who was involved, where it happened, how long it occurred, witnesses, and the result. If necessary, you can attach files below.

Have any damages been suffered? ✱
Yes No

Suffered Damages Please describe. If necessary, you can attach files below.

Attachments

File 6 MB max

Select or "drag and drop"

Remove Change

File 6 MB max

Select or "drag and drop"

Change

+ Add

Discussions

Has this complaint been discussed with the person the incident occurred with? ✱
Yes No

What was the result of this discussion?

Has this complaint been discussed with a MHF staff member? ✱
Yes No

Please specify the staff(s) member(s) You can review names and pictures of our listed staff members here. What was the result of this discussion?

Resolution

How do you wish for the complaint to be resolved?

How would you like to be contacted in response to this complaint? ✱
A reaction by email
A meeting with the complaint officer.
A meeting with the complaint committee.

Cell Number

✱ Required Fields

Contact us

Your confidentiality is key in our organization! Find out more about our privacy policy.

Crisis line

585-5556

Answered by a professional,
confidential.

General: +1-721-542-1677

Extension list

Admission: ext. 513
Care at home: ext. 506/504/511
Clinic care: ext. 501
Day learning center: ext. 507
Short and long stay: ext. 507
Internships and jobs: ext. 516

Admission: +1-721-585-8422
Emergency: +1-721-585-5556

info@mhf-sxm.com

Opening times

Admission: 24/7
Admission visits: 6:00pm → 7:30pm
Clinic care: Mon → Fri, 8:00am → 4:30pm
Care at home: 8:00am → 4:30pm
Day learning center: 8:00am → 3:00pm
Short and long stay visits: 6:00pm → 7:30pm
Prescriptions and refills:
Call from 9:00am → 12:00pm, or Email.

Where are we?