Tennessee Department of Human Services

DHS Logo and Customer Focused

CUSTOMER FEEDBACK FORM

The Department of Human Services is committed to providing quality customer service to all citizens. Our goal is to provide services in a professional, respectful and timely manner. We are constantly striving to improve our processes and value your input. In the event we have exceeded your expectations or did not meet your expectations for quality customer service, please submit a compliment or complaint.

Please identify if this is a: Compliment Complaint          Date:

First Name:               Last Name:

  Address:

          City:      State:       Zip:

Phone

Home:

Cell:

Work:

Email Address:

Services or Program:

Families First/TANF	Food Stamps/SNAP	Child Care
Adult Protective Services	TennCare/Medicaid	Child Support
Vocational Rehabilitation	Disability Determination	Other

Describe your Compliment or Complaint. Please include details that may help us research your case if necessary (County, Names of DHS Staff, relevant dates, your Case Number/ID). If you have attachments you would like to share, please email to DHS.CustomerService@tn.gov or fax at (615)741-4165 and indicate it is an attachment for a Customer Feedback Form submitted.

Thank you for taking the time to provide us with feedback!