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New-Complaint Form doc 2026

The document is a complaint form for the Texas Board of Chiropractic Examiners, allowing individuals to file complaints against chiropractors. It includes sections for personal information of both the complainant and the chiropractor, details of the complaint, and instructions on how to submit the form. The document outlines the process following a complaint submission, including investigation procedures and potential outcomes. Additionally, it contains a Records Release Form for authorizing access to medical records relevant to the complaint.

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Click ‘Get Form’ to open the New-Complaint Form in our editor.
Begin by filling in the 'Name of Chiropractor' and their address details. Ensure accuracy for effective processing.
Next, provide your personal information in the 'PERSON FILING COMPLAINT' section. Include your name, address, and contact numbers.
In the 'PATIENT OR PERSON HARMED BY THE CHIROPRACTOR' section, enter the relevant details including the patient's name and date of birth.
Describe your complaint thoroughly in the 'Details of Complaint' field. Be specific about dates, locations, and treatments involved.
If applicable, indicate whether you have received a second opinion from another healthcare provider and provide their details.
Finally, review all entered information for clarity and accuracy before signing and dating the form at the bottom.

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2019	4.8 Satisfied (70 Votes)

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