Home » About Us » Client Services Form

Client Services Form

We value your feedback and welcome any comments, suggestions and details of your satisfaction and/or dissatisfaction with the program or services. Please complete this form using as much detail as possible.

Full Name of Client:
Client Phone #:
Full Name of Person Providing Feedback:
Relationship to Client:
Phone #:
Resident House While in Treatment:
House Location:

Other Houses Client Resided and Approximate Dates:
Admission Date:
Discharge Date:
Financial (Insurance, Reimbursement, Billing)
Medical (Medications)
Clinical (Program concerns)
Operational (Personal Property, Housing, Transportation)
  • Please provide as much detail as possible, including dates and names of Sovereign Health representatives whenever possible. If your feedback involves a phone conversation, include all phone numbers used to call Sovereign Health.
Requested Resolution:

What Our Clients Say

©2016 SovHealth Treatment Centers. All Rights Reserved. (888) 530-4614 Privacy Policy Terms & Conditions Disclaimer
Close X
Live Chat Software