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TIS Complaint and/or Grievance Form

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Name:

Which Service Office or Individual is the complaint about?

E-mail address: *

Telephone/fax: *

What is the best time to contact you?

Have you already spoken to a supervisor or other personnel at TIS?

If yes to whom?

Please provide details about the complaint: *

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Where to Find Us

Therapeutic Intervention Services Inc.

Corporate Office:

413 Mount Cross Rd. Suite 106

Danville, VA 24540

Phone: (434) 791-3950

Fax: (434) 799-2628

Crisis Line: (434) 791-3950

Family Therapeutic Services

1210 Progressive Dr.

Chesapeake, VA 23320

Phone: (757) 410-0382

Fax: (757) 410-0386

9am-5pm Monday-Friday EST