Complainant Information

All of the information with * next to them are required.

Name: *

Address: *

City: *

State: *

Zip: *

Phone: *

Email: *

Classification: *

Complaint Information

License Number: *
Click here to verify a license number.

If the Complaint is on a Facility, please get in touch with the NC Department of Health and Human Services. If the Complaint is on an Individual that doesn't have a license, you may use the form above to file the Complaint by using the License Number “0” (zero).

Complaint Details:

I certify that I am the person shown above, and all the information is correct.

Complaint Form

Complainant Information

Complaint Information