Continual Care

New Concern

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Please enter your concern below. Describe in as much detail as you can, the "who", "what", "when" and "where" of what you experienced. When finished entering your comments, click the button at upper right, labeled "Submit". Someone from our team will get back to you shortly.

Submitter

I wish to remain anonymous

I will provide some information

Enter your organization name:

Concern

Title:

(*) Provide as many details as you can:

Observed:

Open the calendar popup.

Open the time view popup.

Date Accuracy:

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Injury:

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Location:

Additional Documentation

Supporting Notes:

Files and Photos

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Additional Steps

For more information, send an email to information@iaal.org or call us at 585-256-8900.