CCHA | Grievance Form

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If you have a problem with your Health First Colorado services or providers, we want you to tell us about it. Please use the form below to submit a complaint.

Form User Information

Date Submitted: *

Member Email: *

Member ID: *

Member Name: *

Member Phone: *

Grievance Information

Requested By: *

Member
Provider
Member Representative
Provider on Member's Behalf
Care Coordinator on Member's Behalf

Summary of the Complaint: *

If you need the information on this page in another format, please contact CCHA Member Support Services.

The information will be provided in paper form free of charge within 5 business days.

We can connect you to language services or help you find a provider with ADA accommodations.

If you are having a medical or mental health emergency, call 911 or go to your nearest hospital-based ER.

If you are having a mental health or substance use crisis, call Colorado Crisis Services at 1-844-493-8255.