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AssistCare will make every effort to maintain the confidentiality of the reporter’s identity, but there are times/cases where the individual’s identity may become known or may have to be revealed to resolve the complaint/issue. Anyone, who in good faith, reports a suspected or actual violation will be protected from retaliation. In addition to the form below, you may also report a concern/complaint by calling 1-800-304-8268 or emailing All communication will remain confidential as noted above. We appreciate your feedback.

Would you like to be notified of the findings of this concern, complaint and/or investigation? *

Please select the area(s) of concern related to your report: *

Please explain the details of your concern/complaint including names, dates, and any supporting evidence:


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