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DVOMB Complaint Form

Submission of this form means that you are filing a formal complaint with the Domestic Violence Offender Management Board (DVOMB) against an individual whose name appears on the DVOMB Approved Provider List. The DVOMB has authority only over individual listed providers and can only respond to founded violations of the Standards. Please refer to Appendix D of the Standards for more information about how complaints are processed and reviewed by the DVOMB. 
 
Please complete this form as instructed in its entirety for each individual DVOMB Approved Provider you wish to file a complaint against. Incomplete forms or complaints submitted without complete and necessary information will not be processed. 
Subject
If you would like to remain anonymous, please do not include any of your identifying information below. Please note that anonymous complaints submitted to the DVOMB are reviewed. However, there are times when additional information is needed to process a complaint. By remaining anonymous, the DVOMB will not be able to contact you for more information and your complaint may be dismissed as a result. Anonymous complaints may also be submitted through the Colorado Department of Regulatory Agencies (DORA). Would you like to remain anonymous? (Required)
Complainant Name (Optional)
Complainant Contact Information Email Address (Optional)
Complainant Contact Information Phone Number (Optional)
Service Provider Name (Required) (Required)
Service Provider Email Address
Service Provider Phone Number
Service Provider Address
1. NATURE OF COMPLAINT: Please describe the situation or circumstances related to the violation of the Standards. Continue on a separate sheet if needed and please attach supporting documentation or verification. (Required)
2. STANDARD(S) VIOLATED: The specific DVOMB Standard(s) must be cited and how they were allegedly violated by the provider. Please refer to the Standards and Guidelines for details. (Required)
3. TIMEFRAME: Please describe when did these violations occurred. (Required)
4. DESIRED OUTCOME: Please describe what you would like to occur in order to resolve the situation. (Required)
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