Complaint Form

This form enables you to submit a complaint about a health professional regulated by CHCPBC. To verify the registration of a current CHCPBC registrant, see Licence Verification. If you have a concern about unauthorized practice or unauthorized use of a reserved title by a non-CHCPBC registrant, please do not use this form and instead email complaints@chcpbc.org.

CHCPBC will not receive any information until you have filled all mandatory fields below and clicked the “Submit” button. If you have a large amount of information that does not fit within this form, please email complaints@chcpbc.org.

Please note: CHCPBC is unable to accept anonymous complaints. CHCPBC is required by law to share a copy of your complaint, including your name, with the health professional. However, CHCPBC will not share your personal contact information (i.e., personal email address, phone number, and home address) with the health professional. For more information regarding CHCPBC’s collection and use of personal information submitted through the College website, please see our privacy policy.

If you have any questions about filling out the form and submitting a complaint, please email complaints@chcpbc.org or call CHCPBC at 604-742-6715.

"*" indicates required fields

Your Information

Title (e.g. Mr., Ms., Mx., Dr.)

Pronouns (e.g. she/her, he/him, they/them – this information helps us understand how to address people)

Legal First Name*

Legal Last Name*

Full Name That You Go By (If different from legal name)

Are you submitting this complaint on behalf of someone else?

Yes

Patient/Client Title (e.g. Mr., Ms., Mx., Dr.)

Patient/Client Full Name

Your Relationship to the Patient/Client

Patient/Client Preferred Pronouns (e.g. she/her, he/him, they/them – this information helps us understand how to address people)

Does the Patient/Client consent to filing this complaint?

Yes

Address*

Street Address City Province/State ZIP / Postal Code Country

Phone*

Email*

Note that there is a limit of 4,000 characters in the following three sections: Complaint Details, Witness Information, and Additional Contact Information. If you would like to provide additional information, you may do so by uploading files (up to a total of 5MB for all files) by using the File Upload function at the bottom of this form or emailing CHCPBC: complaints@chcpbc.org

Complaint Details*

Describe the incident(s) that caused your concern(s) about the health professional’s conduct or competence, including when and where the incident(s) occurred. If there is any physical evidence related to your complaint, please indicate that in the Complaint Details section, and save the evidence. CHCPBC will contact you with guidance on how to share the evidence with an investigator.

Witness Information

Do you have any additional witness information to provide as part of this complaint?

Additional Contact Information

Do you have any additional contact information to provide as part of this complaint?

HEALTH PROFESSIONAL YOU ARE SUBMITTING A COMPLAINT ABOUT

This form enables you to submit a complaint about a health professional regulated by CHCPBC. To verify the registration of a current CHCPBC registrant, see Licence Verification.

Full Name*

Professional*

Business Name

Business Address

Business City

Business Province/State

Business Country

Business Postal Code/Zip Code

Registration Number

Business Phone Number

Business Email

Business Website

File Upload

Accepted file types: pdf, Max. file size: 5 MB.

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Name

This field is for validation purposes and should be left unchanged.