I am Making a Complaint on Behalf of Someone Else

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1Consent Form
2Your Information
3Patient Information
4Physician Information
5Main Concerns
6Other Information
7Finalize & Submit
The investigation process generally requires the collection of the patient’s personal and confidential health information. The College requires documentation confirming your authority to represent the patient and receive such information on their behalf.

Please download the Consent Form and choose from one of the sections (A, B or C) that best describes your authority. Depending on the circumstances, the level of documentation required to support your authority may vary. Enclosing the appropriate documentation will allow the College to process your complaint faster.

If you are concerned about medical care received by another person, but do not have that person’s consent to file a complaint, you can contact the College to discuss your concerns. Please note that the College cannot provide details about a patient’s personal health information to a third-person complainant, but will review and take appropriate action on all concerns raised.

If you have questions about how to complete the consent form, please contact the College’s Professional Conduct Coordinator at 709-726-8546 or by email, complaints@cpsnl.ca

Once completed, upload the consent form, and any supporting documentation by using the “Select Files” button below.

Drop files here or

Accepted file types: pdf, jpeg, jpg, Max. file size: 64 MB.

    Please upload completed Consent Form and Will or Power of Attorney, if applicable.