Children and Youth Services Children and Youth Referral Form Children and Youth Assessment Form NFusion Metro Referral Form PACT PACT Referral Form I-CORT I-CORT Referral Form Notice of Grievance Hinds Behavioral Health Services strives to provide quality and professional medical care. If you feel we missed the mark please contact our Consumer Advocate Hotline at 601-321-2400, email cadvocate@hbhs9.com, or reach out to any Hinds Behavioral Health Services staff member to voice a complaint. If your complaint has not been resolved by a method above please complete a formal complaint by submitting a Notice of Grievance Complaint form. Notice of Grievance/ComplaintName* First Last Date*Program/Location*Grievance or Complaint*Please describe in detail the nature of your specific complaint or grievance, listing dates, any staff member(s) involved, etc. Feel free to attach other pages as necessary.Signature of Person Recieving Services or Parent/Guardian*Upload additional information Drop files here or Accepted file types: pdf, doc, docx, jpg. For Program Use OnlyNameThis field is for validation purposes and should be left unchanged. Hinds Behavioral Health Services’ Notice of Grievance/Complaint Form Mississippi Department of Mental Health Grievance Helpline
