Prevention and Intervention Feedback Form
This form is an opportunity for you to voice your concerns and have them addressed in a way that makes you feel heard. You may submit feedback any time you feel you have been treated unfairly by any staff, policy, or other entity related to Sacramento’s Prevention and Intervention team, or if you have suggestions on how we may better do our work. Submitting this form will not impact your participation in the program nor your ability to access services.
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Your Name (leave blank if wish to remain anonymous):
Date of situation being reported (if reporting an incident):
MM
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DD
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YYYY
Please describe with LOTS of details the situation,  interaction, or suggestion you are sharing. Include staff members involved, location, what was done, etc. *
What action would you like to see staff take in response to this? *
What program change or rule revision or other action could be taken to keep this situation from taking place in the future?
Would you like to meet with staff to discuss this matter?
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Who, if anyone, can this form NOT be shared with?
If necessary, may we contact you for more information?
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If you answered yes, please share how we can contact you (your email, phone number, facebook, etc):
Is there anything else you would like us to know before you submit this form?
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