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The North Carolina Respiratory Care Board

Complaint Form

Complainant Information

All of the information with * next to them are required.
Name:
Address:
City:
State:
Zip:
Phone:
Email:
Classification:
*
*
*
*
*
*
*
*

Complaint Information:

License Number:
If the Complaint is on a Facility or an Individual that doesn't have a license you must use this form to file a complaint.
Complaint Details:
*Click here to verify a license number.