Describe your complaint as completely as you can.
Physicians: complaints against physicians should be sent to the New York State Department of Health, Office of Professional Medical Conduct.
All other complaints: should be sent to one of the offices listed on the form; sending the complaint to the wrong agency will delay the investigation.
Authorization: sign and date it and have it signed and dated by a witness; it does not have to be notarized.
Attachments: if you have any papers that may support your complaint, please attach copies; do not send originals.
| Question | Answer |
|---|---|
| Form Name | Professional Discipline Complaint Form |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 26 |
| Avg. time to fill out | 5 min |
| Edition | Rev 8/25 |
| Where to send | Complaints against physicians go to the New York State Department of Health, Office of Professional Medical Conduct; all other complaints go to one of the regional Offices of Professional Discipline |
| Matches the agency's file | Yes, checked October 3, 2026 |
| Other names | Professional Discipline Complaint Form, NY complaint form, NYS complaint form, Office of the Professions complaint form |
| Official source | Professional Discipline Complaint Form (Rev. 8/25), New York State Education Department Office of the Professions |
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