If you have a question or concern, we encourage you to rst speak with your doctor, the patient
advocate at your hospital or a College Public Advisor (1-800-268-7096 ext. 603). Please refer to the
CPSO’s Guide to the Complaints Process for assistance and more information.
To make a complaint, you may complete this form electronically, print it out and mail it to the
address at the end of this form, or submit it online to firstname.lastname@example.org.
Once the College has received your complaint, we will aim to contact you within two business days.
We are required to notify the doctor and may provide him/her a copy of your complaint.
Consent for the release of condential medical information
The investigator handling your complaint will need relevant personal health information.
The investigator may need to get written consent from you or the patient to get certain records.
Person Registering Complaint
Relationship to patient
I am the patient I am representing the patient for the purpose of this complaint
Province Postal code
COMPLAINT FORM | PAGE 1