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Online Grievance Form

Please complete the following to submit an online grievance. If you prefer to file your grievance by mail or by phone, click here to return to the previous page for contact information.

A Phoenix Health Plans representative will acknowledge receipt of a grievance by mail or by phone within 5 business days for a standard grievance OR within 24 hours for an expedited medical grievance.

* Indicates a required field.

(mm/dd/yyyy)
(Physicians first name, last name, facility name, etc.)
(Try to give as much information as you can)

H5985_023-2017 Pending Approval (Updated 9/30/16)