Welcome to the California Department of Alcohol and Drug Programs
STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY
Jerry Brown, Governor

state seal DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS
Office of External Affairs
1700 K STREET
SACRAMENTO, CA 95811-4037
TDD (800) 735-2929


COMMENT/COMPLAINT FORM

Section 8331(a) of the Government Code requires that State Agencies provide a form through which individuals can register complaints or comments relating to the performance of that Agency.
PERSON FILING COMMENT/COMPLAINT:


  WHICH ADP DIVISION/PROGRAM IS YOUR
  COMMENT/COMPLAINT ABOUT?




  ADDRESS (Number and Street):



  PERSON WITH WHOM YOU DEALT:



  CITY, STATE, ZIP:



  LOCATION OF ABOVE:



  TELEPHONE NUMBERS (daytime, with area code):



 FAX NUMBER/E-MAIL ADDRESS (if any):



 STATE YOUR COMMENT/COMPLAINT (Be specific - who, what, when, where, how; attach additional pages if needed):













  HAVE YOU CONTACTED US BEFORE ON THIS MATTER? WHEN? WHO WAS YOUR CONTACT?






 SIGNATURE ______________________________________   DATE__________________________

All information provided to ADP is confidential and subject to the Privacy Act of 1974