Note: If you are a Division of Quality Assurance regulated facility, you must use the Department's Incident Report form to report incidents of alleged misconduct and injuries of unknown source. Completion of this online survey does not meet entity
reporting requirements. Please see
http://www.dhs.wisconsin.gov/caregiver/contacts/Complaints.htm for more information.
* indicates a required field
Protecting and promoting the health and safety of the people of WisconsinThe Official Internet site for the Wisconsin Department of Health Services