Should you have a grievance; please use the electronic form and the appropriate staff member will contact you in a timely manner.

Electronic Grievance Form – On-line Filing

Complete and submit on-line. Grievances Form

Printable Grievance Form – Fax or Mail

You also have the option to print out a hard copy to mail or fax to us.

Printable Grievance Form – English

Printable Grievance Form – Spanish

Upland Corporate Office

1202 Monte Vista Avenue, Suite 17
Upland, CA 91786
Phone: 800-841-2790
Fax # (866) 698-7773