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?

Yes No

Is this complaint being filed on behalf of any agency or employer? If yes, explain below.

Yes No

Person Complaint is Being Registered Against

Is the Dietician or Nutritionist licensed by this Board?

Yes No Unknown

Description of Wrongdoing

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 LBEDN 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.

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