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Discipline Complaint Form

Complaint Form

You or your establishment may print this form and mail it to the OPD office closest to where the incident took place or fax it to: 212-951-6420. For information on filing a complaint call 1-800-442-8106 or email conduct@nysed.gov. Please note, complaints must be submitted in writing and cannot be filed by phone. See instructions below. You may also wish to see a description of New York's professional discipline system.

Instructions for Completing Complaint Form

To complain about service or treatment by a professional licensed to practice by the State of New York, or about illegal practice of a profession by an unlicensed person, complete the COMPLAINT form above and send it to the Office of Professional Discipline. Please note that we do not have authority to investigate fees you believe are too high or to intervene in fee disputes. However, we can investigate complaints involving fraudulent billing.

Type or print clearly in black ink. Describe your complaint as completely as you can. If you do not have a daytime telephone number, it is helpful if you can provide a number where a message can be left for you during the day. If you have any papers which may support your complaint, such as bills or correspondence, please attach copies. Do not send originals. If you have physical evidence, such as incorrectly dispensed medications, it is important for you to retain that evidence in its original condition.

Be sure to sign and date your complaint. Send it to one of the regional offices of the Office of Professional Discipline. When your complaint is received, it will be assigned to an investigator who will contact you in writing or by telephone. You will have an opportunity to explain your complaint in more detail. If we do not have the authority to investigate your complaint, we will refer it to the appropriate agency.

Also, complete the AUTHORIZATION form above by entering your name and the name of the practitioner and/or hospital in the appropriate spaces. The Authorization directs the professional, hospital, or other facility to release information about your treatment or the services rendered to you. Sign and date the Authorization, and have it signed and dated by a witness. A witness can be any person 18 years old or older. The Authorization does not have to be notarized. A completed Authorization helps us investigate your complaint in a timely manner. If you do not want to complete the Authorization, you may leave it blank. However, leaving the Authorization blank may delay the investigation.

IMPORTANT! Complaints against physicians (general practitioners, internists, cardiologists, gynecologists, pediatricians, urologists, psychiatrists, surgeons, radiologists, oncologists, anesthesiologists, ophthalmologists, orthopedists, and others), physician assistants and specialist assistants should be sent to New York State Department of Health, Office of Professional Medical Conduct, Riverview Center, 150 Broadway, Suite 355, Albany, NY 12204-2719. You may call that office at 1-800-663-6114 (Monday through Friday 9:00 am to 5:00 pm eastern) or e-mail the office at opmc@health.ny.gov. All other complaints should be sent to one of OPD's offices. Sending the complaint to the wrong agency will delay the investigation.