Complaint and Concern Reporting Form
Complainant Information
Complainant Information
Name
Address
City
Province
Please select
ND
Alberta
British Columbia
Manitoba
NW Territories
New Brunswick
Newfoundland & Labrador
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
Phone Number
Email
Preferred Method of Correspondence
Please select
Email
Mail
Funeral Service Business Information
Funeral Service Business Information
Funeral Services Business Name
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Branch Location if Other was selected
Name of person you were dealing with/speaking to?
Phone Number
Nature of Concern/Complaint
Nature of Concern/Complaint
Please select the concern of the complaint.
Please select
Funeral
Funeral Goods or Services
Pre-Need Contract
Other, not listed
Name of Deceased
Date of Death
Date of Funeral
Relationship to the Deceased
Were you responsible for funeral arrangements?
Yes
No
My concern is not listed above. My concern is regarding:
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