Complaint Submission Form

This form may be used by any individual who wishes to initiate a formal complaint against a Naturopathic Doctor registered with the College. Before submitting this form, it is recommended that the College’s Complaints Process on the College’s website be reviewed.


As set out in that process, the College will send a written notice of the complaint to the ND (Registrant), together with a copy of this complaint, so that the Registrant can provide a response. Please note that the Complainant’s personal contact information provided on this form WILL NOT be disclosed to the Registrant.


If you do not wish to submit your complaint on-line, you can download a copy of this Complaint Submission Form from the College’s website.

INSTRUCTIONS

Please review the questions provided on the form below and provide as much detail as possible. Once you have completed the form, you are asked whether you wish to receive a copy of your submission. The College strongly recommends that you check this box and enter your email address. A copy of the form will be emailed directly to you for your records. The documents you upload with the form are not included in that email to you.

COMPLAINANT INFORMATION

In the following section, you are asked to provide the requested information about you as the person who is filing a formal complaint.


Please note that your name will be disclosed to the naturopath identified in the complaint.

Please provide your given (first) name.

Please provide your family (last) name.

Please indicate which personal pronouns you use (for example, they/them)

Please provide your street number, street name and unit or suite number, or a postal box number for your mailing address.

Please provide the city, town or community for your mailing address.

Please select the Province or Territory for your mailing address.

Ontario
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Please provide your postal code for your mailing address.

Please provide a telephone number where we can reach you during regular business hours. To change the Country to Canada or another country, please click on the arrow beside the flag.

Phone

Please provide your email address where the College may correspond with you. For security reasons, please ensure that this is an address to which only you have access.

Are you the patient?*

In the concern about which you are filing your complaint, are you also the patient involved?

Please provide the patient's full name.

Please be advised that if you are filing a complaint on behalf of another individual, the College will not be able to disclose the patient’s personal health information without the patient’s consent.

Your Relationship to the Matter*

As you have indicated that your are either a family member or acquaintance of the patient, the patient's employer, or another health care provider, please describe in greater detail what your relationship (if any) is to the patient.

As you have indicated that you are either the ND's employer, a colleague or another health care provider, please specify your relationship to the Naturopathic Doctor.

NATUROPATHIC DOCTOR INFORMATION

In the following section, you are asked to provide as much information as you can about the Naturopathic Doctor (ND) to whom this complaint pertains.

Please provide the full name of the Naturopathic Doctor about whom you are filing this complaint.

Please provide the name of the clinic (if applicable) where the Naturopathic Doctor is providing services.

Please provide the street number and street name for the location where the ND provides services.

Please provide the name of the city, town or community in which Naturopathic Doctor is providing services.

Please select the Province or Territory in which the Naturopathic Doctor is providing services.

Ontario
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Please provide the postal code for the location where the Naturopathic Doctor is providing services.

If you know it, please enter the four-digit College registration number for the Naturopathic Doctor. You should be able to locate this on any invoice or receipt you may have from them or you may search their name on the College's Naturopathic Doctor Search.

COMPLAINT DETAILS

In this section, you are asked to provide as much detail as possible about the events that give rise to the filing of this complaint

Please provide as much detail as you can about the circumstances that have lead you to file a complaint against this ND.

Have your concerns been brought to the attention of the Naturopathic Doctor in question?*

Please describe the outcome or results of your discussion with the Naturopathic Doctor about your concerns.

Please be sure to provide name and contact information (telephone or email) for each person you list.

Please upload each of the documents you listed in the field above.

Drag and drop files here or

DECLARATIONS AND SIGNATURE

Please review the following section carefully.

The information that I have provided is true and accurate to the best of my abilities.*
I confirm that I wish to file a formal complaint about the Naturopathic Doctor identified in this form.*

Signature


By checking the box below, you are affixing a signature to this form and indicating that this form and the information contained herein is bound directly to you.

COPY OF SUBMISSION

Below is a check box to enable you to receive a copy of your submission. It is highly recommended that you check this box and enter your e-mail address. This will enable the on-line system to send you a copy of the information that you have provided to the College.

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