Forms Mental Health Packet Mental Health SUD Packet Prime for Life Packet Release of Information Form Form Process StepsFill out formBring in to one of the locationsGreen Apple will screen for services and schedule an appointment Grievance Report Grievance Report Name of Grievant Name of Grievant First Name First Name Last Name Last Name Date of Grievence (MM/DD/YYYY) Client of Green Apple Client of Green Apple First Name First Name Last Name Last Name Phone Number Statement of Grievence Relief Sought Request Meeting Yes No Meeting Date (MM/DD/YYYY) Grievance Signatures Grievance Signatures First Name First Name Last Name Last Name Date (MM/DD/YYYY) Recieved by Recieved by First Name First Name Last Name Last Name Date (MM/DD/YYYY) Rectified Grievant Signature Grievant Signature First Name First Name Last Name Last Name Date (MM/DD/YYYY) Green Apple Director Green Apple Director First Name First Name Last Name Last Name Date (MM/DD/YYYY) Submit If you are human, leave this field blank. If you have any questions about the forms, please call us at 406 866-0350
