How to Fill Out the NY Professional Discipline Complaint Form

The NY Professional Discipline Complaint Form is a one-page document you file with the Office of Professional Discipline (OPD) to report misconduct by a state-licensed professional such as a nurse, pharmacist, dentist, architect, or accountant. Print it from the New York State Education Department’s Office of the Professions website, fill in both the complaint section and the Authorization section on the same PDF, and send it by mail or fax to the OPD regional office closest to where the incident happened.¹ Complaints have to be in writing. You cannot file one by phone.²

Before You Start the Form

OPD handles complaints against more than 50 professions licensed under Title VIII of New York Education Law, including nurses, pharmacists, dentists, psychologists, architects, professional engineers, land surveyors, mental health counselors, licensed social workers, public accountants, and physical therapists.³

One boundary matters before you fill anything out. Complaints about physicians, physician assistants, and specialist assistants do not go to OPD. Those practitioners fall under the Office of Professional Medical Conduct (OPMC) at the New York State Department of Health, which runs a separate process under Public Health Law Section 230.⁴ If you are not sure which office covers the person, check their license type through the Education Department’s online verification search.³

Your complaint also needs to describe conduct that fits what Education Law Section 6509 defines as professional misconduct. The categories most people file under include practicing beyond the scope of a license, gross negligence or incompetence, practicing while impaired by alcohol or drugs, obtaining a fee through fraud, failing to keep adequate records, and unprofessional conduct as further defined by the Board of Regents for each profession.⁵ A billing dispute or personality conflict, with no underlying violation of professional standards, is unlikely to go anywhere.

Filling Out the Complaint Section

Print the form from the OPD website or request a copy by calling 1-800-442-8106.² Use black ink and print clearly. Typed submissions are also fine.¹

Your Information

The top block asks for your full name, mailing address, city, state, zip code, county, daytime phone, evening phone, and email. A daytime number matters because investigators will want to reach you for follow-up. If you don’t have one, OPD asks that you give a number where a message can be left during business hours.¹ You must include your name and contact details. The form does not accept anonymous complaints.

Information About the Professional

Next you identify the practitioner. The form asks for the person’s name, profession, phone number, and the name and address of the hospital, business, or store where the services were provided.⁶ A license number is not strictly required, but adding one prevents confusion when professionals share similar names. You can look it up through the online verification search before you start writing.

The Narrative

The main body is open-ended. Describe what the professional did or failed to do, when it happened, and where. Stick to facts and keep inflammatory language out of it; investigators care about what occurred, not how upset you are about it. Name any witnesses. If you run out of room, attach additional sheets. Sign and date the bottom of the complaint before you send it.⁶

Don’t Skip the Authorization Section

The same PDF includes a separate Authorization form, and this is the piece most people miss. Signing it directs the professional, hospital, or facility to release your treatment or service records to OPD investigators.¹

Fill in your printed name and the name of the practitioner or hospital in the spaces provided, then sign and date it. You also need a witness, any person 18 or older, to sign and date the form. The Authorization does not need to be notarized.⁷

You can leave the Authorization blank, but that slows the investigation because OPD will have to pursue your records through other channels. If the complaint involves treatment or services you personally received, completing it up front saves time.

What to Attach

Include copies of anything that supports the complaint: bills, receipts, contracts, written correspondence, appointment records. Send copies only. OPD does not return submitted materials.¹

If you have physical evidence, such as incorrectly dispensed medication, do not mail it. Keep it in its original condition and mention in your narrative that you have it. An investigator will tell you how to handle it.

Where to Send the Form

Mail or fax the completed complaint, the signed Authorization, and your supporting documents to the OPD regional office closest to where the incident took place. The fax number for all offices is 212-951-6420.¹

The regional offices and their mailing addresses are:²

Manhattan: 163 West 125th Street, Suite 302, New York, NY 10027
Brooklyn and Staten Island: 55 Hanson Place, Suite 601, Brooklyn, NY 11217
Bronx and Queens: 2400 Halsey Street, Bronx, NY 10461
Long Island: 250 Veterans Memorial Highway, Room 3A-15, Hauppauge, NY 11788
Mid-Hudson: One Gateway Plaza, Third Floor, Port Chester, NY 10573
Albany: 80 Wolf Road, Suite 204, Albany, NY 12205
Syracuse: 333 East Washington Street, Suite 211, Syracuse, NY 13202
Rochester: 85 Allen Street, Suite 120, Rochester, NY 14608
Buffalo: 295 Main Street, Suite 562, Buffalo, NY 14203

If you mail it, pick a service that gives you a tracking number so you have proof of delivery. For questions before you file, OPD can be reached at 1-800-442-8106 or conduct@nysed.gov.⁸

What Happens After You File

A Supervising Investigator at the regional office reviews your submission first. If the complaint is outside OPD’s jurisdiction or doesn’t contain enough information to suggest a violation, the case is closed and you receive a written explanation.⁹

If it moves forward, a Senior Investigator is assigned to gather facts and interview relevant parties, including you. After the investigation, a three-way screening involving the Senior Investigator, a Prosecuting Attorney, and a Board Member from the relevant profession decides whether the evidence supports formal charges. If it does, the case moves to the Prosecutions Division. If it does not, the case is classified as “no action” and closed.⁹

Most investigations finish within nine months. Many prosecuted cases end in a negotiated settlement, but complicated matters can run two years or more from the first complaint to a final order. You will be kept informed of the status along the way and told the final outcome.⁹

1
Office of the Professions. Discipline Complaint Form
2
New York State Education Department. NYS Professional Misconduct Enforcement – OPD Regional Offices
3
New York State Education Department. Online Verification Searches
4
New York State Department of Health. Physician and Physician Assistants Disciplinary and Other Actions
5
New York State Education Department. Education Law 6509 – Definitions of Professional Misconduct
6
The State Education Department. New York Professional Discipline Complaint Form
7
Office of the Professions. Professional Discipline Complaint Form
8
New York State Education Department. Professional Misconduct Enforcement
9
New York State Education Department. Frequently Asked Questions – Enforcement