Online Complaint Form - Virginia Department of Social Services

Online Complaint Form

×
Child care programs are under the oversight of the Virginia Department of Education. Complaints regarding child day programs may be submitted here.

Note: * Indicates required information.

Complaint

Facility name:

Facility address:

*Street:
*City:
*State:
*Zip:

Phone:

*Type of facility:

Assisted Living
Adult Day Care
Children's Residential Facility
Child Placing Agency

*Type of report:

Complaint
Allegation of illegal operation
Self-report

*Report details:

Include names, dates and times associated with specific incidents. Also include the names of individuals who may have knowledge of specific incidents.

Person Filing Complaint

Note: Anonymous complaints will be accepted. However if you do not provide your contact information, a licensing inspector will not be able to contact you if additional information is needed. We encourage you to provide complete and specific information.
Name:

Mailing Address:

Street:
City:
State:
Zip:

Phone:

E-mail:

*Affiliation with provider:

Employee
Former employee
Resident
Consumer
Local agency
Other

Please explain:

Find this content at:
http://www.dss.virginia.gov/about/email_licensing_complaint.cgi