Senior & Disabilities Services

Quality Assurance
Tell Us About It: Feedback Opportunities

 

 

The Division of Senior Services is committed to ensuring quality care and services to Alaska's seniors and vulnerable adults. We welcome your feedback on our efforts. Please fill out this form as completely as possible so that we may appropriately respond to your concerns. The information provided on this form will be shared only on a need-to-know basis as we look into the nature of the feedback you have offered.

Please fill out form below as completely as possible:

NOTE: Leave name fields blank if you wish to remain anonymous.

First Name:

Last Name:

I am submitting this as a member of an organization (media outlet, advocacy agency, etc.)

Name of Organization:

I am not submitting this as a member of an organization

Address:

City:

State:

Zip Code:

Telephone:

E-Mail Address: (only if you'd prefer a response via e-mail)

I have a general comment or question that I would like addressed.
I have a specific complaint that I would like addressed.

Comments: