Complaint Form

Required fields are marked with *

Contact Information

First Name *
Last Name *
Address *
Unit / Suite
City *
Province *
Postal Code *
Email *
Phone *

If you are not the patient please describe your relationship to the patient (parent, guardian, spouse, child, relative, lawyer, friend) and provide details about the patient below:

Please Note: If you are making a complaint on behalf of another individual, the College may require the individual to provide consent to access personal information relating to the complaint. A consent form will be provided with the acknowledgment letter. If you are a regulated health professional, employer or facility operator who wishes to report the sexual abuse of a patient, please click here for more information.

Communications from the College

Telephone and Regular/Registered Mail: The College may need to communicate with you in writing or via telephone regarding your complaint. Written correspondence is typically sent via regular and/or registered mail.

Email Correspondence: In order to ensure prompt and efficient consideration of your complaint, the College may also communicate with you via email. The College will not send personal health information or other sensitive information via email unless you indicate below that it is your preference to receive all written correspondence from the College via email. The College recognizes that email may not be secure, and while we take steps to protect all emails, we cannot guarantee the security and confidentiality of any email you receive from the College.

Please indicate below if you prefer to receive all written communications from the College via email:

The College may send me all written communications relating to my complaint by email, including communications that include personal health information and/or other sensitive information, and I understand that the College cannot guarantee the security or confidentiality of any email I receive from the College.

I prefer that the College send me sensitive communications (e.g. those that include personal health information) by regular mail and/or registered mail

Patient Contact Information

Patient contact information is the same as above
Patient First Name *
Patient Last Name *
Address *
Unit / Suite
City *
Province *
Postal Code *
Email *
Phone *

Registrant Information

Please provide as much information as possible.

College registrant you are making a complaint against?	Optician Intern Student
First Name
Last Name
Registration Number
Name of Optical Dispensary
Address
Unit / Suite
City
Province
Postal Code
Email
Phone

Additional Registrants

If applicable, you may add additional registrant names below

Registrant #2 - First Name
Registrant #2 - Last Name

Registrant #3 - First Name
Registrant #3 - Last Name

Registrant #4 - First Name
Registrant #4 - Last Name

Complaint Details

Please provide as much detail about your complaint as possible, including the following: *

A chronological description of the events that took place between the patient and the Registrant, including the reason(s) you are concerned about the Registrant's care, behaviour, etc.
Dates of service
A description of any efforts you have already made to resolve this matter
Any supporting documentation with an explanation of how each document relates to your concern

Supporting Documents

If you wish to provide any supporting documents, please upload them below.

Add Another Document

The College will send written notice of your complaint to the Registrant, together with a copy of the Complaint Form. **Please note, however, that the Complainant/Patient Contact Information Sheet will not be disclosed to the Registrant.

You will receive an email confirmation, with a copy of your complaint upon submission.

Protecting the Public