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Complaint Against WIC Clinic

Formal Discrimination Complaint

If you would like to file a formal Discrimination Complaint against a Nevada WIC Clinic, Follow the directions found here

Click here to read the full Nevada WIC Non-discrimination Statement (English) (Spanish)

Anonymity
- I would like to be anonymous
Witness Contact Information
Your name and at least ONE contact method is needed for the State Office to be able to follow up on this complaint. If 'anonymous' is selected, we will not share your name with the Clinic.
Name*
First Last
Home Phone
Cell Phone
Email
Complaint Type
You may check up to four (4) complaint types.
- Poor customer service
- Unavailable appointments
- Denying services
- Poor clinic environment
- Threatening or verbally abusive towards WIC participants
- Denying access to a breast pump
- Denying issuance of a requested food (infant formula, milk) to a client
- Physically abusive towards WIC participants
- Unfairly requesting additional eligibility documents
- Violation of client privacy/confidential information
- Failure to offer clients the same courtesies offered to others
- Discriminate on the basis of race, color, disability, age, national origin, or gender
- Failure to inform client about WIC procedures (WIC foods, using food instruments)
- Not opened during declared clinic hours
- Suspicion of being involved in program fraud/abuse
Complaint Information
Date of Incident
MM slash DD slash YYYY
Time of Incident

:
Which clinic?*
What happened?
Describe the Incident
Phone
This field is for validation purposes and should be left unchanged.

About WIC
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Contact

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Staff
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WIC Healthcare Providers

© 2020 - State of Nevada - Division of Public and Behavioral Health | Nevada Internet Privacy Policy

The WIC Program is prohibited from discriminating on the basis of race, color, national origin, sex, age or disability. | USDA Nondiscrimination Statement: (English) (Spanish)

To file a complaint of discrimination, write to: USDA, Director, Center for Civil Rights Enforcement, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410.