Get Ny Professional Discipline Complaint Form 2020-2025

This guide will help you navigate the process of filling out the New York Professional Discipline Complaint Form online. Whether you are reporting an issue with a licensed professional or an unlicensed individual, these instructions will provide you with the clarity you need to complete the form accurately.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor. This action will allow you to begin the process of lodging your complaint.
2. Fill in your personal information in the designated sections. This includes your name, address, city, state, zip code, county, daytime and evening telephone numbers, and email address. Ensure all entries are clear.
3. Provide information regarding the individual or entity you are complaining about. This section requires the name(s) of the professional, their profession, and any relevant contact information such as telephone number and address.
4. Describe your complaint in detail. Specify what occurred, when it took place, and where the incident happened. Use black ink for clarity, and if necessary, include additional sheets to elaborate on your complaint.
5. Confirm the accuracy of your information by signing and dating the form. This ensures that the complaint is submitted formally.
6. Complete the Authorization section by entering your name and the name of the professional or facility involved. Sign and date this section, and ensure a witness signature is obtained, as a witness must be a person aged 18 or older.
7. If you have any supporting documents, attach copies to the form. Original documents should not be sent as they cannot be returned.
8. Choose whether to include any additional sheets. If you do, check the designated box on the form.
9. Finally, save your changes, and choose to download, print, or share the completed form as necessary.

Complete your complaint by filling out the NY Professional Discipline Complaint Form online today.