FORMS

File a Complaint

Please fill out the following form using the CAPS LOCK feature on your keyboard.

Person Registering Complaint

Anonymous complaints will not be accepted.
Are you a licensee?
Is this complaint being filed on behalf of any agency or employer? If yes, explain below.

Person Complaint is Being Registered Against

Is the Speech-Language Pathologist or Audiologist licensed by this Board?

Include specific details such as names of people involved, dates, location, particulars about the alleged violation(s), and any other pertinent facts.

If you have any additional documentation regarding this complaint that you would like to provide to the Board, please mail it to the LBESPA office.

By typing your name in the signature field, you are signing this agreement electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this agreement.