Ethical Complaint Form

This page allows you to file a complaint against a Substance Use Disorder Professional in North Carolina. A Substance Use Disorder Professional is a Registrant, Intern/Associate or certified/licensed professional covered by the North Carolina Addictions Specialist Professional Practice Act.

Please be aware of a few caveats when filing your Complaint:

Anonymous Complaints are by standard procedure not investigated.
An ethics investigation cannot proceed without admissible evidence. Hearsay evidence cannot be used in an disciplinary proceeding.
Some complaints are dismissed due to being a personnel matter. Please recognize the difference between a personnel matter and a possible ethical breach.

If you do not know some of the information regarding the Respondent, then mark that field “N/A.”

I, the undersigned, hereby complain against:
Name of Credentialed Person You Are Complaining Against*
Address (N/A If Unknown)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
A registered, certified or licensed substance abuse professional of:
County*
I agree to cooperate by furnishing representatives of the North Carolina Substance Abuse Professional Practice Board all pertinent information and records in my possession concerning the alleged misconduct of said professional. I further agree that if a hearing or inquiry is ordered concerning the alleged misconduct of said professional, then I will furnish evidence concerning the facts by submitting to depositions or personal attendance at that hearing or inquiry. I understand that the costs of my appearance in furnishing said evidence may be taxed against me in the event my attendance must be compelled because of my failure to cooperate with either the North Carolina Substance Abuse Professional Practice Board or its Ethics Committee.

I hereby indicate that this information is provided and transmitted by me to the North Carolina Substance Abuse Professional Practice Board for the purpose of investigating the alleged misconduct of the above named professional. I understand that I may reveal this information to a privately-retained attorney to pursue remedies on my behalf.

I also understand that the North Carolina Substance Abuse Professional Practice Board may reveal this information to the accused professional for his or her response to a formal inquiry and to others pursuant only to the Rules of the North Carolina Substance Abuse Professional Practice Board. Additionally this information may become public only upon the direction of the North Carolina Substance Abuse Professional Practice Board, pursuant to its policies and procedures.
Your Name*
Your Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home Telephone*
Office Telephone*
Email*
In support of said complaint, the above complainant being duly sworn, state that the following are the true facts concerning the complaint to his or her own personal knowledge:
Affidavit*
Please attach copies of any correspondence or other documents which support your complaint:
Supplementary Documentation
Drop files here or

Accepted file types: doc, docx, pdf, jpg, png, Max. file size: 100 MB, Max. files: 5.
Name
This field is for validation purposes and should be left unchanged.

Ethical Complaint Form

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