Instructions for Completing Complaint Form
To file a complaint about the treatment you received from a physician (M.D., or D.O.) or physician assistant licensed to practice medicine by the State of New York, please complete this form and return it to the Office of Professional Medical Conduct, NYS Department of Health, 433 River Street, Suite 303, Troy, New York 12180-2299. Phone: (518) 402-0836 or 1-800-663-6114.
Trained staff will review the information you give. We will investigate all matters of possible professional misconduct. If your complaint requires the attention of another office, it will be sent to the agency authorized to address your concerns.
To help us review your complaint, please:
- Type or print clearly in ink.
- Describe your complaint as completely as you can.
- Include the names of any witnesses.
- Include the names of others with whom you filed a complaint.
- Attach additional pages, if needed.
- Attach copies of papers which may support your complaint, such as bills or correspondence. Do not send originals.
- Please sign and date the form.
