File a Service Concern or Complaint

We apologize for any unfortunate experience you've had. We're here to help. Please use the form below to file an official service concern or complaint and we will do what we can to resolve this issue.

    Required Field *

    Client's First Name *

    Client's Last Name *

    Client's Phone Number *

    Client's Email Address *

    Client's Street Address *

    Client's City *

    Client's State *

    Are you the client filling out this form? *

    Your First Name *

    Your Last Name *

    Your Phone Number *

    Your Email Address *

    Please list any staff members involved. *

    Please detail the concern/complaint and any steps taken to resolve it prior to this formal complaint. *

    How can we help resolve this concern/complaint? *

    Additional Info or Questions

    Agentic Logo

    We serve Franklin County and the surrounding areas.

    General Contact Form

    Application Form