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Create Complaint

This form is designed to assist you in filing a complaint regarding a podiatrist (DPM). You will assist the North Carolina Board of Podiatry Examiners in investigating your complaint by providing as much of the requested information as possible. You may upload or attach any additional pages or other information relating to your complaint.

Your Information:

Please note: If this complaint cannot be shared with the podiatrist, the Board will accept it as information only and no further action may be taken.

CONTACT INFORMATION FOR THE PODIATRIST (about whom the complaint is made):

SPECIFICS OF YOUR COMPLAINT:

On the following line please summarize in one sentence the concern you have regarding the podiatrist:

YOUR COMPLAINT

PLEASE SUMMARIZE IN DETAIL YOUR CONCERNS REGARDING THIS PODIATRIST.Include the dates of key events, as well as names of people (including how we might contact them) who may have information helpful to the Board of Podiatry Examiners. Also include any other information which you feel may be helpful to the Board.(You may attach additional pages, if needed.)

Attachment
More information
  • Files must be less than 2 MB.
  • Allowed file types: jpg jpeg gif png txt doc docx xls xlsx pdf ppt pptx pps ppsx odt ods odp mp3 mov mp4 m4a m4v mpeg avi ogg oga ogv weba webp webm tiff.

Terms and Conditions

Please note that use of this online complaint submission process forwards your information and documents to a document-sharing portal that is secured with login and password accessible only to individuals appointed by the Board.

You are acknowledging by your submission of the information included in your complaint and any attachments, including any otherwise personal information and/or protected health information, that all such information will be reviewed as part of the investigation and possible, disciplinary process, and by your signature acceptance below you are expressly authorizing the sharing of this information with members of the Board’s Grievance Committee, Board Counsel, Board Staff, Board Members, and the Respondent (podiatrist about whom you are complaining) as may be necessitated by the investigation and possible disciplinary process.

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