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ADA Complaint Form

Please note!

The Americans with Disabilities Act of 1990 (ADA) prohibits discrimination and ensures equal opportunity and access for persons with disabilities.

Any person who believes that they have been discriminated against by the city of Phoenix, or one of the city’s service providers, and believes that the discrimination is based solely upon their disability, may file a complaint with the city. Any such complaint must be in writing and filed within 180 days following the date of the alleged discriminatory occurrence.

To file a complaint online, please complete and then submit this form. It is pre-addressed to arrive at the correct destination when you click on the “Submit” button below.

If you have questions or comments about the process, or want to email the ADA/Title VI Coordinator directly, please use this email address:

In order for us to respond to your message appropriately, please fill in as much of the following information as possible.

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Incident Information *

Customer Information

Advocate Information

Incident Information

(Please enter in format: HH:MM AM/PM)
(Month, Date, Year; i.e. Jan. 1, 2019)
Major Crossroads: *

Crossroad One:

Crossroad Two:

Operator Name and/or Description:

Vehicle Number and/or Description:

Complaint Details

Additional Complaint Information



Please attach any additional material that is relevant to your complaint.

The combined size of all uploaded files is limited to 20MB.
File Size:
File Size:
File Size:
File Size:

Electronic Signature *

Please enter your full legal name above. This will be considered your signature.