Resources & Information

Complaint Form

indicates required field

Name of Person Making Complaint
Patient's Full Name
(if different from complainant)
Information about the PHYSICIAN (MD, DO) or PHYSICIAN ASSISTANT you are reporting (not a practice or hospital name)
Complaint

It is recommended that you compose your complaint statement as a document and save it to your computer. You may cut and paste the text of your statement into the space below, or send your statement as an attachment. This will provide you with a written record of your complaint and prevent the loss of your statement in the event of technical difficulties with this form.

How did you hear about the NC Medical Board?
Attachments
(medical records, correspondence, etc.)

You will receive an auto reply to the email entered above. If you do not receive this email, your submission was not received.

You may contact the Complaint Department if you have any issues or questions.