Survey & Certification Web Inquiry Form

This form is not to be used for submitting an S&C Complaint or making a report of abuse, neglect or exploitation.

Use this link to submit an S&C Complaint.

The form below allows you to e-mail Survey & Certification with your questions and concerns.

Survey & Certification takes every inquiry and comment very seriously and asks that you fill out the form as completely as possible so your questions or problem can be addressed.

Emails will be responded to in a timely manner.

Please note that the State Offices are open for business Monday through Friday from 7:45 am to 4:30 pm except for Holidays, and are closed on the weekends.

Fields marked with the red * are "required" fields.

Your Name

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Your Email Address

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Your Phone Number

Enter your Phone Number, please include Area Code. Number format is: 802-123-4567

Subject

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Questions/Comments

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