Find out more about our grievance procedures below. We always encourage questions and feedback.

Download Policy and Form Documents

Please visit the following link to download our Grievance Policy.

Please visit the following link to download our Patient grievance Form (or you can fill out the form on this page and submit it electronically):

Interrupting: Grievance Form

If you prefer to submit your grievance form electronically, please use this form.

You may be questioning yourself, but please don’t. Our work can be triggering and bring up different complex emotions and release certain feelings about past events and traumas, and we can’t always predict how different people can respond. Please feel free to bring that forward and any other incidents you would like to discuss. We are more than happy to discuss it.

(Fields marked with * are required.)

First Name:

Last Name:


Phone Number:

What happened?

When did it happen?

Who was involved?

What was the harm that was done? How did you feel?

What would be the best solution? What do you want to happen now?

Possible next steps (please select any that may work for you):
 peace circle one-one conversation with someone at sage you trust one-one conversation with someone outside of sage option to write a peace note soliciting a written apology mediated conversation with an outside facilitator other

Please add more details here. If you chose “other” above, you can also specify other next steps below.

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A member of Sage will contact you within one week of receiving this form.

Thank you,
Sage Community Health Collective Members