File a Complaint | Vermont Department of Health CLOSE Translations for you File a Complaint Board of Medical Practice COVID-19 Licensing & Information Applications, Licensing & Fees File a Complaint Board Actions Look Up A Health Professional Board Meetings & Board Members Frequently Asked Questions & Important Links Statutes, Rules, Policies & Newsletters The Vermont Board of Medical Practice investigates complaints of unprofessional conduct, and may issue reprimands; or revoke, suspend, or place conditions on professional licenses and certifications, or take action where appropriate to protect public health and safety. If you have a concern about a medical professional licensed by the Board, please click on the following link that will bring you to the online platform. You may file as a guest, registered user, or licensee. Registration is NOT required. Please note that you will still need to submit, via email to [email protected] , the Authorization Release to Disclose PHI and the Authorization for Release of Medical Records forms, linked below. If you do not wish to use the complaint platform, please complete the appropriate forms from the list below. We encourage electronic submission of these forms by sending them to the email address below. Forms are provided in a fillable PDF format. Digital signatures are acceptable when completing these documents. To access the digital signature portion of the fillable format, you must download and complete the form in Adobe. Free versions of Adobe can be found at Download Adobe Acrobat Reader: Free PDF viewer . Instructions to setup an Adobe digital signature can be found here. NOTE - To investigate a claim, the Board must receive these 3 forms. The Complaint form The Authorization Release to Disclose PHI The Authorization for Release of Medical Records form Scroll down for all of our forms If you have questions, email [email protected] or call (802) 657-4220. Email Address: [email protected] Mail Address: Vermont Board of Medical Practice, 280 State Drive, Waterbury, VT 05671-8320 Translated Complaint Forms in: العربیة)Arabic) Bosnian ြမန်မာစာ (Burmese) 中文 (Chinese - Simplified) 中文 (Chinese - Traditional) دری (Dari) Français (French Canadian) Kirundi नेपाली (Nepali) پښتو (Pashto) Soomaali (Somali) Español (Spanish) Kiswahili (Swahili) Українська (Ukrainian) Tiếng Việt (Vietnamese) Complaint Forms FORMS DESCRIPTIONS Complaint Form For full description of concern or complaint. Release of Medical Records Authorization Form For your own medical records. Authorization to Disclose Protected Health Information - PHI For obtaining PHI that is relevant to your complaint. Consent for a Child Form For medical records for your child or a child for whom you are guardian. Holder of Power of Attorney Form For medical records of a person who is living for whom you have Power of Attorney. Personal Representative Form For medical records of a person who is deceased / you were able to participate in health care and had a Power of Attorney, were named in an Advanced Directive, or as a guardian or conservator. Executor of the Estate Form For the medical records of a patient who is now deceased, and you are the Executor of the Estate. This title varies among states, and may also be personal representative, administrator, trustee, etc. depending upon the location of the estate. Additional Information Definition of Unprofessional Conduct Internal Guidelines for Investigation Procedures (07/30/2020) Complaint and Investigative Process If you require immediate assistance or have questions about legal issues pertaining to health care, you may contact Vermont Legal Aid, Health Care Advocacy at 1-800-917-7787 or visit the website for more information. Vermont Legal Aid, Health Care Advocacy For recent Board actions taken on licensees please review our Board Actions List Board Actions List Translated Complaint Forms Complaint Form: العربیة (Arabic) Bosnian မြန်မာစာ (Burmese) 中文 (Chinese - Simplified) 中文 (Chinese - Traditional) دری (Dari) Français (French Canadian) Kirundi नेपाली (Nepali) پښتو (Pashto) Soomaali (Somali) Español (Spanish) Kiswahili (Swahili) Українська (Ukrainian) Tiếng Việt (Vietnamese) Release of Medical Records Authorization Form: العربیة (Arabic) Bosnian မြန်မာစာ(Burmese) 中文 (Chinese - Simplified) 中文 (Chinese - Traditional) دری (Dari) Français (French Canadian) Kirundi नेपाली (Nepali) پښتو (Pashto) Soomaali (Somali) Español (Spanish) Kiswahili (Swahili) Українська (Ukrainian) Tiếng Việt (Vietnamese) Consent for a Child Form: العربیة (Arabic) Bosnian မြန်မာစာ (Burmese) 中文 (Chinese - Simplified) 中文 (Chinese - Traditional) دری (Dari) Français (French Canadian) Kirundi नेपाली (Nepali) پښتو (Pashto) Soomaali (Somali) Español (Spanish) Kiswahili (Swahili) Українська (Ukrainian) Tiếng Việt (Vietnamese) Holder of Power of Attorney Form: العربیة (Arabic) Bosnian မြန်မာစာ (Burmese) 中文 (Chinese - Simplified) 中文 (Chinese - Traditional) دری (Dari) Français (French Canadian) Kirundi नेपाली (Nepali) پښتو (Pashto) Soomaali (Somali) Español (Spanish) Kiswahili (Swahili) Українська (Ukrainian) Tiếng Việt (Vietnamese) Personal Representative Form: العربیة (Arabic) Bosnian မြန်မာစာ (Burmese) 中文 (Chinese - Simplified) 中文 (Chinese - Traditional) دری (Dari) Français (French Canadian) Kirundi नेपाली (Nepali) پښتو (Pashto) Soomaali (Somali) Español (Spanish) Kiswahili (Swahili) Українська (Ukrainian) Tiếng Việt (Vietnamese) Executor of the Estate Form: العربیة (Arabic) Bosnian မြန်မာစာ (Burmese) 中文 (Chinese - Simplified) 中文 (Chinese - Traditional) دری (Dari) Français (French Canadian) Kirundi नेपाली (Nepali) پښتو (Pashto) Soomaali (Somali) Español (Spanish) Kiswahili (Swahili) Українська (Ukrainian) Tiếng Việt (Vietnamese) Topics: Harm Reduction Medical Licensing/Certification Resources for Health Professionals Resources for Nurses Resources for Physician Assistants Resources for Physicians March 23, 2026