Georgia Professional Licensure Complaint Form

Please use the following form to submit a complaint to the Georgia Professional Licensing Boards division.
Please be sure that your complaint pertains to one of the professions regulated by the Boards.

Your Information
 
Your Name (Required):    
Address (Required):   Complete Address (include street, city, state and zip) 
Telephone (Required):    
Fax:  
Email (Required):    
 
Area of Complaint

Please place an 'X' in the box or boxes next to the area that pertains to this complaint.

Quality of Care/Service  
Unlicensed Practice  
Unprofessional Conduct  
Other  
 
Information About Individual or Facility Involved
Name of Licensee/Professional Entity:  
License Number:  
Address:  Complete Address (include street, city, state and zip)
Phone: 
Have you brought any legal action
against this licensee/professional entity? 
 
Detailed Complaint Information
 

Please provide a detailed explanation of your complaint. Include names, addresses, dates, etc. regarding all parties involved.
 

Your complaint will be given serious consideration by the board and further investigative action may be taken, if appropriate. You may be contacted by the board investigator. A referral of a complaint for further investigation does not necessarily mean that a licensing violation has occurred. Investigations are completed as soon as possible, depending upon the nature and circumstances of the complaint. Investigative files are considered confidential (pursuant to O.C.G.A. 43-1-19(h) (2)) for any purpose other than a hearing before the board; however, the board is authorized to release such records to another enforcement agency or lawful licensing authority.