Licensing Menu Licensing Boards Architects and Interior Designers Athlete Agents Athletic Trainers Athletic & Entertainment Commission Auctioneers Behavior Analyst Licensing Board Chiropractors Conditioned Air Contractors Cosmetology and Barbers Dietitians Dispensing Opticians Electrical Contractors Foresters Funeral Directors & Embalmers Geologists Hearing Aid Dealers and Dispensers Immigration Lactation Consultants Landscape Architects Librarians Long-Term Care Facility Low Voltage Contractors Massage Therapy Music Therapy Nursing Occupational Therapy Optometry Physical Therapy Plumbers Podiatry Private Detectives and Security Agencies Professional Counseling | Social Work | Marriage & Family Counseling Psychology Residential and General Contractors Speech Language Pathology and Audiology Trauma Scene Waste Management Used Motor Vehicle Dealers Used Motor Vehicle Parts Dealers Utility Contractors Veterinary Medicine Water and Wastewater Treatment Plant Operators and Laboratory Analysts Licensing Services Apply for a License Renew Your License Download Application Forms Check Application Status Print Your License Address and Email Updates Search Facility and Business Licensees Active License Statistics Verify A License Purchase A Roster Of Licensees Search Individual Licensees Search Facility and Business Licensees Purchase A License Verification Rules & Regulations Professional Licensing Board Rules and Regs License Expiration and Renewal Dates How A Loan Defaults Or Child Support Can Impact Your License Professions Not Under Secretary of State Certified Nurse Aide Dentists Insurance Agents Lawyers Pesticide Applicators Pharmacists Physicians Real Estate Agents Breadcrumb Home > The Licensing Division of the Georgia Secretary of State’s Office > Licensing Complaint for Individual Form Licensing Complaint for Individual Form Please be sure you have selected your specific board from this list before you proceed. Licensed Individual Complaint Individual Involved in Complaint First Name Last Name License Number? Profession License Type - Select -Architects & Interior DesignersAthletic & Entertainment CommissionCemeteriesChiropractorsConditioned Air ContractorsDietitiansDispensing OpticiansElectrical ContractorsForestersGeologistsHearing Aid Dealers and DispensersLandscape ArchitectsLow Voltage ContractorsMusic TherapyNursingOptometryPlumbersProfessional Counselors, Social Workers and Marriage & Family TherapistsPsychologyResidential and General ContractorsSpeech Pathologists and AudiologistsUtility Contractors Did you take legal action or make a police report? Yes No Tell Us About Yourself First Name Last Name Address City State - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Email Phone Number Area of Compliant Please select which pertains to your complaint. You can select all that apply. Action by another board agency Advertising Quality of care Unprofessional conduct Fraud Other Detailed Complaint Description Please provide a detailed explanation of your complaint. Include names, addresses, dates, etc., regarding all parties involved. Attachment(s) Unlimited number of files can be uploaded to this field.24 MB limit.Allowed types: jpg, jpeg, png, tif, tiff, pdf.24 MB limit per form. CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Leave this field blank