Use this form to let Variety Care know about any issue, incident, complaint or comment that you may have regarding your Variety Care Experience.

For example:

• to let us know about an experience (good or bad) you had at Variety Care
• reports of incidents or occurrences of wrongdoing, misconduct, fraud, or HIPAA issues
• reporting an incident or injury
• any other concerns or compliments

If you have any trouble using this form, you can print and mail a paper copy of this form by clicking the language you would like: English or Spanish

Please provide all the details you have, including:

• A description of what happened;
• Who was present (staff, visitors or patients);
• Any specific concerns, complaints or compliments; and
• Information about previous experiences like this one.

After you click "Submit," a confirmation message with a green check mark will appear to indicate your report was received.