Alpine County, CA · Alpine County
Queja, Apelación Estándar y Forma de Apelación Apresurada
Alpine County Behavioral Health Services clients use this Spanish-language form to file a grievance or request a regular or expedited appeal.
At a glance
- Issued by
- City of Alpine County · Alpine County, Alpine County, California
- Notarization
- Not required: file this form without a notary.
- Official source
- alpinecountyca.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This Spanish-language form lets Alpine County Behavioral Health Services clients report dissatisfaction or request a regular or expedited appeal of an action. It asks for the type of request, the filer’s and client’s contact details, the request date, the reason, and the client’s signature and date. The form explains the grievance and appeal processes and gives the county’s mailing address for completed forms.
Who needs it
Alpine County Behavioral Health Services clients, or someone filing on a client’s behalf, can use it to submit a grievance or appeal request.
How to submit it
Return the completed form to Alpine County Behavioral Health Services, 40 Diamond Valley Rd., Markleeville, CA 96120.
About notarization
This form is signed and dated without a notary; no notarized or sworn attachment or related step is mentioned.
How to submit this form
- 1
Download the Form
Download the Spanish grievance, regular appeal, and expedited appeal form.
- 2
Complete the Request
Select the request type and provide the filer’s and client’s information, request date, and reason.
- 3
Sign and Date
The form includes a space for the client’s signature and date; it does not list required attachments.
- 4
Submit to the County
Return the completed form to Alpine County Behavioral Health Services at 40 Diamond Valley Rd., Markleeville, CA 96120.
Frequently asked questions
- What is the Spanish grievance and appeal form for?
- Alpine County Behavioral Health Services clients can use it to file a grievance or request a regular or expedited appeal. It also describes the processes.
- Who can file this form?
- A client can file a grievance or appeal request, and the form says someone else may call or write for a client. A representative may also be authorized during an appeal.
- Do I need a notary for this grievance and appeal form?
- No. The form calls for the client’s signature and date, not notarization. It does not mention a notarized or sworn attachment or related step.
- How do I submit the grievance and appeal form?
- Return the completed form to Alpine County Behavioral Health Services, 40 Diamond Valley Rd., Markleeville, CA 96120.