Instructions on Completing Inquiry/Suggestion Submission Form
Please use the Inquiry/Suggestion Submission Form (Form) below to submit your general wellness or infection control questions or suggestions to the Office of the Ombudsman (Office).
The only required field in the Form is the “Description of Inquiry/Suggestion.” field.
The fields labeled “First Name,” “Last Name,” “Phone No.,” “Email Address,” “DOC Facility Name,” and “Relationship with DOC Facility” in the Form are optional. You may leave these fields blank if you wish to submit anonymously. However, please be aware that the Office will be unable to respond to anonymous inquiries or suggestions submitted without contact information.
If you choose to provide your contact information, the Office of the Ombudsman (Office) will make every effort to respond within two (2) business days.
The Office reserves the right to exclude any unrelated or unverified inquiries or suggestions.
Additionally, If you consent to the Office sharing your name with the DOC to help facilitate a response, please check the “Yes, I am willing” box in the Form.
Once you have completed the Form as desired, click the blue “Submit” button to send your inquiry or suggestion to the Office.
If you experience any issues with the Form or have related questions, please email the Office at ombudsman@umassmed.edu using the subject line “Question on Inquiry/Suggestion Submission Form.” A member of the Office will respond promptly.
You may contact the Office toll-free at 833-662-8410. Follow the instructions on the voicemail to leave a message, inquiry, or suggestion.
Inquiry/Suggestion Submission Form
Please be aware that, unless an exception applies, your inquiry will be considered a public record, which could be subject to production. See MGL c. 66, Section 10.
Please do not include any personal identifying information such as health or medical information in your message, as this is not an encrypted message format.
Any personal information submitted will not be used, published, transferred, sold or otherwise disclosed for any purpose that is not directly connected with this website or the Office of the Ombudsman except as provided by law or with the prior written consent of the individual or personal representative of the individual who is the subject of the personal information. Reasonable steps are taken to protect any personal information submitted from unauthorized use, access, disclosure, alteration, or destruction.