Consumers

Submit Complaint By Mail

Complaint forms can be obtained by calling the Central Complaint Unit or by filling out the following form:

• Consumer Complaint Form
• Download Consumer Complaint Form: EN | SP

A complainant may be asked to sign a medical records release form if the Board needs to obtain medical records from a doctor, hospital or other sources to investigate a complaint. If the complaint is NOT within the Board's jurisdiction, staff may provide a referral to the appropriate agency or organization.

Complete the "Authorization for Release of Information For The Subject Of The Complaint" (Subject is the physician or other healthcare provider you are complaining about)

Complete one of the following medical release forms in their entirety:

• "Physician/Provider/Facility Authorization for Release of Information" (In this form you will list all treating facilities in addition to all relevant treating providers specific to your complaint. If the incident is involving a surgical procedure, it is important that you list any pre-op or post-op providers) -OR-
• "Kaiser Authorization for Release of Information" (should care and treatment have been rendered at a Kaiser facility please fill out the enclosed Kaiser form and check if it's a "northern" or "southern" facility)

*** Should the patient be deceased, the person signing the release form(s) must be a legal representative as demonstrated on a durable power of attorney, death certificate, or an executor of will/estate document. (Please enclose copy of supportive documentation).