You do not have to fill out this whole form. If you prefer, you may give only:
- Your name
- Phone number
- Email address
Later, Iowa Senior Medicare Patrol (SMP) may need more information to better help you.
Iowa SMP will not contact this individual or business without getting your permission first.
The information on this form will be transmitted to the Iowa SMP. It will be seen only by Iowa SMP and law enforcement authorities to which Iowa SMP may refer your complaint for further action.