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Complaint form

PART I – IDENTIFICATION OF THE COMPLAINANT

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PART II – THERAPIST IDENTIFICATION

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PART III – QUESTIONS AND DESCRIPTION OF YOUR COMPLAINT

We understand that this statement may be difficult to write. We hope to gather as much information as possible to identify the person in question and prepare our file. If your condition requires assistance in completing the statement, please let us know in writing. A committee member will contact you upon receipt of your statement.

What is the nature of your complaint? *

sexually explicit behavior
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Professional negligence
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Is the subject of the complaint aware of your action? *

No
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Yes

Have you contacted a lawyer or another organization in order to proceed with a lawsuit in connection with your complaint and if so, specify? *

No
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Yes
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We invite you to consult the RITMA code of ethics, available at all times on our website at RITMA.CA, which will inform you about the commitments and responsibilities of the therapist or the intervener targeted by your complaint.

PART IV – RELEVANT DOCUMENTS SUPPORTING THE DESCRIPTION OF YOUR COMPLAINT

Please attach to this form all copies of documents that you consider important and that can help us in the analysis of your complaint, in particular a copy of a contract, invoice, statement, receipt, proposal, document needs analysis or other that would have been given to you by your therapist. Please list the numbered documents you intend to attach to your complaint.

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confirm that the above information and statements are true and undertake to collaborate to the best of my knowledge in the investigation process that will be initiated by my complaint. I also hereby authorize the members of the ethics committee as well as the members of the RITMA board of directors to have access to the personal information and the complete content of this complaint necessary for the investigation process.

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