Response

Thank you for filling out the Department of Social and Health Services Online Customer Complaint Form.

At DSHS, we deliver a variety of social services, employment support, safety programs and court-ordered behavioral health care. We work in close collaboration with other state agencies and community partners to fulfill our mission:

We partner with people to access support, care, and resources.

We will work to resolve your concerns as quickly as possible. Please fill out this form to the best of your ability. While a phone and email are required to submit a question, concern, or complaint to our team, we understand that people do not always have access to these tools. If you do not have a phone number or email address, please enter a placeholder (such as 'N/A' or 'None') in those fields and specify how we can contact you to provide further assistance.

Please note: All fields marked with an asterisk (*) are required.

Type of Feedback

Subject

CLIENT or PERSON NEEDING SERVICE (Please note: All fields marked with an asterisk (*) are required.

Prefix

First Name

Middle Name

Last Name

Suffix

ACES Number

Title

Organization

Address Line 1

City

State

Zip

Daytime Phone

Cell Phone

Evening Phone

Date of Birth (Please enter Birthdate in the following format MM/DD/YYYY)

REQUESTOR INFORMATION (if different than above)

Prefix

First Name

Middle Name

Last Name

Suffix

Daytime Phone

Primary/preferred language?

Would you like a response?

PLEASE TELL US ABOUT YOUR REQUEST OR CONCERN.

Preferred contact method:

Please do not include any personal information like Social Security numbers, client identification numbers, etc., in your form. We are unable to communicate about any personal information by email, and we want to protect your privacy.

If you selected fax number, please provide in the box below.

ADDITIONAL INFORMATION: Use this space to tell us the details about your request or concern. Please limit your response to 500 total letters and numbers.

Please attach supporting documents (PDF, Word or Excel), up to three files and no larger than 15MB each.

Upload FileNo file chosen

If you require auxiliary aid or service for effective communication, such as an interpreter, video remote interpreting services, transcription services, written materials, assistive listening device, captioning or any other method to deliver information or to participate in a program, service or activity of DSHS, you must contact the program that offers that service as soon as possible but no later than 48 hours before the scheduled event. If you are unable to contact the specific program offering the service or activity, the DSHS ADA Coordinator can assist with routing the request for accommodation. The DSHS ADA Coordinator can be reached by phone (564-201-0718) or by email (adacoordinator@dshs.wa.gov).