TO: THE REGISTRAR, P O BOX 205, Pretoria, 0001 COMPLAINT-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the 'DETAILS OF COMPLAINANT / REPRESENTATIVE' section. Enter your title and full names, date of birth, identity or passport number (mandatory), nationality, country of origin, postal address, physical address, cellphone number, landline number, fax number, and email address. If you are a representative, ensure to attach the Power of Attorney.
3. If applicable, complete the 'DETAILS OF THE PATIENT' section with the patient's title and full names, identity number or birth date or passport number, postal address, physical address, cellphone number, landline number, fax number, and email address.
4. In the 'DETAILS OF PRACTITIONER' section, provide the name of the practitioner along with their physical address (not PO Box), HPCSA registration number, practice number, cellphone number, telephone number, fax number and email address.
5. Detail your complaint in the 'DETAILS OF COMPLAINT' section. You may also attach additional documents relevant to your complaint if necessary.
6. Indicate what outcome you expect from this complaint. Note that an acknowledgment letter will be sent within 7 days; financial compensation is handled through courts.
7. Fill in the date and place fields before signing as the complainant.
8. If applicable for patients above 12 years old or next of kin consent is required for deceased patients. Ensure to sign and date these sections accordingly.

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