Problem Prevention Report

Section 1: About You

You may submit this form anonymously. However, providing your name and contact information may help us better understand the situation or follow up if needed.

First Name:

Last Name:

Phone Number:

Email:

Your role in the situation (required) *

REALTOR®

Consumer

Client

Other (indicate below)

Section 2: The REALTOR® Involved

Please provide as much information as you can. If you're not sure of exact names or details, include anything that may help us identify the REALTOR®.

Name of REALTOR® (required): *

Their company/brokerage:

Location (city or county):

Section 3: What Happened?

Please include relevant dates, what occurred, and any steps you’ve already taken to address the issue (if any).

Description of Events *

Section 4: Permissions & Preferences

Please check all that apply:

I give permission for the Association to contact the REALTOR® about this issue on my behalf

I would like a staff member to follow up with me directly

I would prefer to remain anonymous to the REALTOR®

I understand that submitting this form does NOT initiate a formal complaint or investigation

Section 5: Additional Information

Is there anything else you'd like us to know?

Thank you for submitting a Problem Prevention Report. Our staff will review the information provided. If follow-up is appropriate and you’ve indicated that you would like to be contacted, we’ll be in touch. Please note: This is not a formal complaint, and the REALTOR® involved may or may not be contacted depending on the nature of the report. We appreciate you helping us uphold high ethical standards in our profession.

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