HARBOR HOMES INC. 1.K.

3
CLIENT COMPLAINT FORM
Facility / Agency /
Provider / Program: GPD
Complaint filed by: Frank Farris
(Client /Family Member)
I can be reached at:
Address 335 Somerville Street #204 Manchester NH 03103 Phone # 603-440-4477
COMPLAINT INFORMATION
Date: May to present Time: Varies Location: Independence Hall

Name or Descriptions of Individuals involved in the incident/situation of complaint:

Transitional residents of apartment 304 (above me)

Name(s) of witnesses of incident / situation:

Brandon Marks (friend), Cody Morin, Desiree Farris, both my children

Brief Narrative of the incident / complaint: (continue on reverse side if you need additional space)
This is the second time I have been forced to file a noise complaint about the neighbors’ kids making
noise. I am writing this at 2:28 AM on a Thursday after having been woken up yet again by running,
slamming and screaming for over half an hour. This has become a daily and nightly occurrence, not an
hour goes by without some sort of excessive noise. I need this to be addressed this time; I have to be at
work in four and a half hours and this is impacting every aspect of my life. This has been going on for
EIGHT MONTHS, and I cannot and should not have to keep calling the police about this.

I understand that further interviews with the Vice President or his/her designee, other staff, or a review of my clinical record may be
necessary to fully investigate this matter. I therefore give the Vice President or his/her designee authority to conduct the necessary
investigation. I also understand that I have the right to have someone assist me with the complaint. If I am not satisfied with the
results of the investigation, I have the right to file a complaint with the Office of Client and Legal Services at 1-855-450-3593.
.
Name of Complainant:_____Frank Richard Farris______________ Date: ___12/21/2023________

Name of Staff Receiving/handling complaint: ______________________________Date: ______________

Date: Time: Location:
Follow Up/Resolution:

(continue on reverse side if you need additional space)

Client received a copy of resolution: ☐ in person ☐ by mail
☐ Client would like further investigation
☐ Client would like to request a meeting with Client Rights Representative
Client:
☐ My signature indicates that my complaint has been resolved to my satisfaction.

Signature of complainant: Date:

Staff:
☐ My signature indicates that client gave a verbal indication over the phone that this complaint has been
resolved to their satisfaction.

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Signature of staff: Date: Time:

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Recommendations to Administration to prevent similar complaints:

Client Rights Committee Follow-up:

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