To file a consumer complaint online, please click below, fill out the form and click "Send. When filing a complaint, please explain your problem simply and concisely.Here's a sample to help you write a complaint letter about a product or service. General Inquiries or Complaints. Consumer Action offers a sample complaint letter and an email complaint template. You can cut and paste these documents below. How can I submit a complaint to the department? Complete form 84901. Complaint Forms, Licensed Health Care Facility Complaints, Complaint Form for Unlicensed Health Care Facilities, Office of Medicaid Program Integrity. Write a complaint letter and submit with all documentation that supports your claim.