A) Fill in the caption, index number and each blank on the form. Make sure that your answers are accurate, complete and legible.The Division of Human Rights complaint form is available at the below link. You may use this form to file and submit your complaint online. Complaint sample. PDF. Complaint fill in. PDF. Call 718-99-BRONX (718-992-7669) for important assistance in accessing BronxCare Health System during and after hours. If you believe you are a victim please contact the Bronx DA's Civilian Complaint Unit at 718-590-2300 or fill out the corresponding form below. Please upload any evidence that may support your complaint (images, audio, video, documents, etc.) and describe the evidence that you are providing. When filing a complaint about a physician, you must mail your written letter or completed complaint form to the New York State Department of Health.