Complaint Form

Your Concerns Matter

If you are experiencing a need to file a complaint, please feel free to complete following form, and it will be emailed directly to our Administrator.
Prosperity Homes Inc. will work diligently to ensure your concern is heard and that an appropriate action is taken to help resolve any issues you may be having.
If you are filing on the behalf of an individual, we will work closely with you to determine the problem and ensure the individual receives a quality resolution.
You may be asked to participate in an investigation and/or quality improvement review.
If you work with the individual in question, please remember to also submit an incident report to your immediate supervisor.

If you know the name of the individual receiving services, please indicate it here.

Type Anonymous if you would prefer not to be known

Please use the following format: 555-555-5555

Check all that apply

Note: If you are an employee of Prosperity Homes Inc. supporting an individual with submitting this form and if the Coercion, Neglect, Abuse, Rights Violated, or Exploitation complaint type is checked, you must submit an accompanying incident report.
This form will be submitted directly to the management personnel at Prosperity Homes Inc. The Program Manager and Administrator will be notified immediately of this form’s submission. An investigation will commence and all parties involved will be interviewed to help establish evidence aid in determining the following actions.
No reprisal, retaliation, or punishment will be enacted against the submitter of an earnest complaint.