Accessible Customer Service Feedback Form

MCAP is devoted to providing customer service that is accessible to those clients with disabilities and ensure that customer service is delivered in a way that takes into account the person’s disability. We welcome feedback to help us improve our services. Please fill out the information below to provide feedback or request our services in an alternate accessible format.

Full Name:

Telephone Number:

Email Address:

Do you require accomodation? Yes No

(If yes, please provide details on the type of assistance required below)

Do you have feedback on the accessibility of MCAP services? Yes No

(If yes, please provide details below)

Please provide the details of your feedback or request:

Personal information obtained on this form is collected for the purposes of responding to your request or feedback.