Ombuds Office Visit Request Form

Visit Request Form

Request an appointment with the Ombuds using this secure and confidential form. Alternatively, call us on (617) 355-2865. Please note, it may take a day or two for us to reach out.

Name

Non-US phone number

Personal cell phone or non-work number

Confirm Phone Number

When should we call you back?

(we will try our best to reach you at your preferred time)

Okay to leave voicemail?

Yes No

How do you prefer to meet with us?

Your comfort and ability to fully express yourself is important to us. What should we know or have in place to ensure that? (i.e., interpreting services, closed-captioning, no overhead lighting, an ombuds with a certain gender expression)