If you believe that one of your rights have been violated, you (or someone on your behalf) may use this form to make a complaint. A Rights Officer/Advisor will review the complaint and may conduct an investigation.

You can reach the Office of Recipient Rights at 1-800-281-0481.

The form is available now in Microsoft Word and Adobe Acrobat (PDF). You will need Adobe Acrobat Reader to be able to view and print this form. The PDF format can only be printed and filled out by hand. The Microsoft Word format can be saved to your computer, filled out and then printed and mailed.

Your Rights When Receiving Mental Health Services in Michigan

Recipient Rights Advisory/Appeals Committee

Recipient Rights Advisory/Appeals Committee – Application

Recipient Rights Complaint Form – Microsoft Word Format

Recipient Rights Complaint Form – PDF Format

Authorization to Disclose Employee Background Information – Microsoft Word format