To assist you with your Unlicensed Complementary and Alternative Health Care Practice complaint, the Minnesota Department of Health asks that you complete the form linked below. Please type or print clearly, using blue ink.
Narrative description of your complaint
- Describe what occurred, where and when the incident transpired and who was involved.
- Include in your narrative your relationship to the practitioner, where the practitioner was employed at the time of the incident, and any previous or subsequent encounters you may have had with the practitioner.
- When possible, include the identities and phone numbers of anyone who may have either witnessed the incident or have additional information regarding either the incident or the practitioner.
- Include copies of any supporting documents you may have.
- If you need more space, you may include additional pages.
- Sign and date each statement of complaint page.
- Your rights are described in the Tennessen Warning included in the complaint form linked above.
Sign and submit the complaint form, with your written statement, via U.S. Mail to:
Health Occupations Program
Office of Unlicensed Complementary and Alternative Health Care Practice
Minnesota Department of Health
P.O. Box 64882
St. Paul, Minnesota 55164-0882
Based on the information you provide, an investigation will be conducted.