Complaint Against a Health Facility/Provider
To submit a complaint to the Licensing and Certification Program against a health facility/provider, please fill out the fields below and click the submit button. Please provide as much detailed information about the complaint to help us complete a thorough investigation.
Printable Complaint Form (PDF)
*Fields denoted with an asterisk are required fields
Section 1 - Your contact information
Section 2 - Confidentiality
Section 3 - Residents/Patients/Clients
Section 4 - Complaint Against
Section 5 - Complaint
Step 6 - Verification
To successfully submit your complaint, please enter the 5 character security code located in the light blue box.