Funeral Home/Funeral Director Complaint Form

Directions: Please be sure to complain to the company or individual before filing. Make sure you enclose copies of important papers concerning your transaction.

Complainant
What is your relationship to the decedent?
Complaint
Were your funeral expenses prefunded?
Type of Preneed Agreement:
Your Relationship:
How did you pay? (Check those which apply):
Did you sign a contract?
Did you contact the funeral home/funeral director regarding your complaint?
If Yes,
Nature of contact:
Has matter been submitted to another agency or attorney?
If Yes,
Is court action pending?
What is the nature of the complaint? (Check all that apply)

Please provide the following information about another funeral home or funeral director involved in the matter about which you are complaining.
Provide the information about another funeral home or funeral director involved in the matter about which you are complaining
more items
Witness Information
Name Day Phone Evening Phone Operations
more items

 

 

READ THE FOLLOWING BEFORE SIGNING BELOW

PLEASE ATTACH TO THIS FORM PHOTOCOPIES of any applicable documents (contracts, warranties, bills received, cancelled checks,correspondence, etc)

Upload requirements

NOTE:In order to resolve your complaint, we may send a copy of this form to the funeral home or funeral director about whom you are complaining.


In filing this complaint, I understand that the Department of Health is not my private attorney, but represents the public in enforcing laws designed to protect the public from misleading or unlawful business practices. I also understand that if I have any questions concerning my legal rights or responsibilities, I should contact a private attorney. I have no objection to the contents of this complaint being forwarded to the business or person the complaint is directed against. The above complaint is true and accurate to the best of my knowledge.


I also understand that any false statements made in this complaint are punishable as a Class A Misdemeanor under Section 175.30 and/or Section 210.45 of the Penal Law.


Signature

 

 

COMPLAINT PROCESS

Please complete the attached complaint form, and return it along with corroborative documents and witness statement, when applicable.


Please be advised any information you provide may be subject to public disclosure. If an investigation into the matter is conducted,the information and findings are subject to public disclosure only after the investigation is completed. You are also advised the completed complaint form is a “government record” which the Department may be obligated to provide to anyone making a request pursuant to the Freedom of Information Law (FOIL).


The disposition of the complaint may take several months. Please understand the Department can only take formal action if it finds sufficient basis that the funeral firm and/or funeral director has violated Public Health Law and/or its implement regulations. If the completed investigation is referred to the Department’s Division of Legal Affairs, formal charges may be filed and the respondent would be given the opportunity to defend himself or herself. The process can take a considerable period of time.


If your complaint involves a dispute over fees, please be advised the Department regulates the disclosure of fees, but has no jurisdiction over the amount charged.


You will be notified in writing when the complaint investigation findings are finalized and the action, if any, taken by the Department.


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