Please provide your name, address, daytime telephone number, as well as the name and address of the chiropractor. While we do not wish to complicate the filing of complaints, we ask that you please provide as much detail as you can regarding all facts which relate to the complaint, including treatment dates, references to records which you may have or know about, and any attempts you may have already made to resolve your complaint with the provider. The information requested is essential in conducting a thorough investigation of the allegations. Failure to provide needed information may result in the return of your complaint form. You may include as many pages of comments and supporting documents as you feel are necessary.

Although the Board accepts anonymous complaints, state law requires that you provide your name. Your identity will be kept confidential from the public however the Board may be compelled to release your name to the doctor involved in your complaint. Upon receipt of your complaint, a copy will be sent to the chiropractor with instructions to respond in writing. A copy of the chiropractor’s written response will be mailed to you for your review and at that time, you may provide additional comments to the Board. Your complaint will be placed on a future agenda for the Board to review and determine what action, if any, is necessary. You will be notified of the Board’s meeting date, time, and location and are welcome to attend and discuss the complaint with the Board.