Get Comlaint Form

This guide provides a clear, step-by-step approach to completing the Complaint Form online. By following these instructions, you can ensure that your concerns are reported accurately and effectively.

Follow the steps to fill out the form accurately.

1. Press the ‘Get Form’ button to access the Complaint Form and open it in your preferred document viewer.
2. In the complainant information section, fill in your full name, address (including street, city, state, and zip code), as well as your home and work phone numbers.
3. Next, locate the licensee information section. Here, input the name and address of the alleged violator, ensuring you provide their street address, city, state, and zip code, along with their home and work phone numbers.
4. If applicable, move on to the client-patient information section. Fill in the necessary details such as their name, address, and phone numbers. Specify your relationship to the client and indicate whether the client is a minor by selecting ‘Yes’ or ‘No.’ If ‘Yes,’ provide the client's age.
5. In the supporting documentation section, include any relevant documents such as receipts or notes that support your complaint. Be sure to list the names, addresses, and phone numbers of individuals who may have further information regarding the alleged violations.
6. Detail the specifics of your complaint. Enter the dates of your client-patient/licensee relationship, the dates of the alleged violations, and a comprehensive description of the complaint.
7. Finally, review all provided information for accuracy. After confirming that everything is correct, you can save changes to your document, and choose to download, print, or share the completed form.

Submit your documents online to ensure your complaint is formally recognized.