Professional Conduct Review Form

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Complainant First Name: *

Complainant Last Name: *

Complainant Address: *

Complainant City, State, Zip: *

Complainant Phone: *

Complainant Email: *

GCM First Name: *

GCM Last Name: *

GCM Company Name: *

GCM Address: *

GCM City, State, Zip: *

Description of Complaint: (max 5000 characters) *

What steps have been taken to resolve this issue? (max 5000 characters)

The GCM service agreement or contract for services was signed by: (max 1500 characters)

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[DISCLAIMER]
The purpose of this process is to promote professional behavior by NAPGCM members. The NAPGCM Professional Review Process is not a dispute resolution mechanism, nor a means to pursue legal or financial remedies. Fee and similar contract disputes involving consumers are generally outside the scope of this process.  We recommend that persons with such concerns discuss them directly with the care manager. If the outcome is unsatisfactory, other options include a local Better Business Bureau, formal Alternative Dispute Resolution organizations or a professional licensing body.