Complaints against the IAC must be reported using the form below for submitting a complaint against the IAC. The IAC will acknowledge your complaint submission and contact the complainant as warranted. Information Of Person Filing ComplaintName First Last Title PhoneEmail(Required) I am (select one only)(Required) Employee of Currently Accredited Facility Employee of a Facility Seeking Accreditation Potential Customer Vendor Consumer Information Regarding ComplaintNATURE OF COMPLAINT (select one only)(Required) Accreditation Process Customer Service Other Provide specific details regarding the alleged complaint including name any persons involved, dates, times:(Required)Attach any supporting documentation in the box below. Remove any patient-related personal information from documents unless the complaint is being submitted by or on behalf of the patient.Max. file size: 32 MB.HAVE YOU CONTACTED ANY OF THE FOLLOWING IN RELATION TO THIS COMPLAINT? (select one only):(Required) Yes, any members of the IAC staff (i.e., Supervisor) Yes, any other IAC department (i.e., Compliance) Other No, I have not contacted anyone regarding this complaint I have contacted:(Required) Date Complaint Submitted(Required) MM slash DD slash YYYY Consent(Required) By checking this box, I declare, under penalty of perjury, that the information in this complaint is true and complete to the best of my knowledge.CommentsThis field is for validation purposes and should be left unchanged.