Banner for Internet English

Complaints, Grievance and Appeals Form


Complaints, Grievance and Appeals Form

You can file your Complaint, Grievance or Appeal by completing the Complaints, Grievance and Appeals Form. Please be sure to complete all form fields. Once all is done you can deliver it visiting our Service Offices, or you can send it by fax at 787-300-3931 and 787-300-3932, by email at querellas-beneficiarios@fmsaludpr.com or by mail at:

First Medical Health Plan, Inc.

Grievances and Appeals Department- FM Vital

PO Box 195079

San Juan, PR 00919-5079

If you need a copy of the Complaints, Grievance and Appeals Form, please feel free to contact First Medical Customer Service at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805, Monday through Friday from 7:00 a.m. to 7:00 p.m. First Medical will send you free of charge, the Complaints, Grievance and Appeals Form in five (5) business days from the date of your request.