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Online Grievance Form
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If you have a grievance against your health plan, you should first telephone your plan,
Valley Health Plan, at 408.885.4760 or 1.888.421.8444
and use the Plan's
grievance process
before contacting the Department of Managed Health Care (DMHC).
Date
*
(mm/dd/yyyy)
Member Name
*
Street Number
*
City
*
Zip Code
*
Phone
*
When did this happen (including date and time if possible)?
*
Where did this happen (name of clinic, office, by telephone etc.)?
*
Description of Grievance (Please be as specific as possible, using dates and names whenever possible.)
*
How would you like to see this grievance resolved to your satisfaction?
*
Related Articles
DMHC Consumer Help-Line
Grievance and Appeals Process
Member Grievances
Forms & Documents
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