Person Making Complaint (Complainant)
Personal Pronouns
What is your relationship with the nurse or midwife (registrant) who you are complaining about?
Please specify your relationship to that person by choosing one of the options below and complete Form B - Authorization to Submit a Complaint:
Details of the Registrant (provide as much information as possible)
Person who you are making a complaint against
Please describe your concern in as much detail as possible, including the date(s) and time(s) of each incident if known.
Witness #1 Information
Please identify any individuals who were present at the time the incident(s) occurred, or have information relevant to the compl
Witness #2 Information
Please identify any individuals who were present at the time the incident(s) occurred, or have information relevant to the complaint.
Do you have any supporting documents, images, or videos you would like to include with your complaint submission?
Please upload any supporting documents you would like to include with your complaint.
Unlimited number of files can be uploaded to this field.
50 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.
Unlimited number of files can be uploaded to this field.
50 MB limit.
Allowed types: gif jpg png svg.
Unlimited number of files can be uploaded to this field.
50 MB limit.
Allowed types: avi mov mp4 ogg wav webm.