Get Or Obmi Consumer Complaint Form 2020-2025

This guide will help you understand how to complete the Oregon Board of Medical Imaging Consumer Complaint Form online. Follow the steps outlined below to ensure your submission is clear and complete.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the OR OBMI Consumer Complaint Form and open it in your preferred document editor.
2. In the 'Complainant’s Contact Information' section, enter your last name, first name, middle name, mailing address, city, state, zip code, phone number, and email address. Ensure all information is accurate and complete for effective communication.
3. If you wish for someone else to represent you in this matter, fill in their name, address, city, state, zip code, phone number, fax number, and email address in the representative's section. Make sure you trust this individual as you are allowing communication regarding your complaint.
4. In the section regarding the 'Name of Technologist or Facility,' fill in the relevant information, including the mailing address and license number of the technologist or facility involved in your complaint.
5. Specify the type of medical imaging modality related to your complaint by selecting one from the given options such as M.R.I. technologist, nuclear medicine technologist, ultrasound technologist, and others. This information will help clarify your issue.
6. Provide the factual details of your complaint in the designated area. Include specific dates, locations, and witness information if available. You may attach additional sheets if you have more details to add.
7. Read the declaration and affirmation statement carefully. You will need to confirm that the information provided is true to the best of your knowledge and belief by printing or typing your full name in the designated area, followed by your signature and the date.
8. Finally, after reviewing the completed form for any errors or omissions, save your changes, and you may choose to download, print, or share the form as needed. Click on the relevant button to submit your complaint form to the Oregon Board of Medical Imaging.

Ensure your voice is heard by completing and submitting the OR OBMI Consumer Complaint Form online today.