Ala. Admin. Code r. 630-X-A-1 – Complaint Form - 630-X-3-.01

Rule 630-X-3-.01

ALABAMA BOARD OF OPTOMETRY

How To File A Complaint

Any person may file a complaint with the Alabama Board of Optometry.

Complaints against licensed optometrists for unprofessional, unethical, or illegal conduct and complaints against any other person who may be accused of violating any provision of the Alabama Optometry Law can contact the Executive Director in writing and under oath (signed, including the phrase "Sworn to and subscribed before me ..." and notarized).

The Alabama Board of Optometry is responsible for investigating unprofessional, unethical, or illegal acts, and does not pursue consumer complaints. These complaints are directed to consumer rights organizations.

The complaint must set out in detail the charge(s) against the accused person and must contain a telephone number at which the person registering the complaint can be reached by telephone.

Mail the notarized complaint to:

Dr. Fred Wallace
Executive Director
Alabama Board of Optometry
1431 Second Avenue, North
Bessemer, AL 35020

If you have questions about these procedures, you may contact Dr. Wallace at (205) 481-9993 or fred.wallace@optometry.alabama.gov.

You may use the attached Complaint Form. Please include all facts that you feel are important, including date(s), names of all individuals involved, and any information that would assist in our investigation.

All documentation that you attach become the property of the Board and cannot be returned.

The Board will contact you upon receipt of your complaint, may request additional information, and will notify you of its decision concerning the complaint.

Alabama Board of Optometry
1431 Second Avenue, North
Bessemer, AL 35020
(205) 481-9993
(205) 481-9959 fax
www.optometry.alabama.gov

Complaint
Please type or print legibly

Your Name:

________________________________________________________________________

Your Home Address:

________________________________________________________________________

Your Work Address:

________________________________________________________________________

Your Home Phone:

________________________________________________________________________

Your Work Phone:

________________________________________________________________________

On whom are you filing this complaint (include an address)?

________________________________________________________________________

Explain your complaint:

________________________________________________________________________

ATTACH ADDITIONAL PAGES IF NECESSARY

Attach photocopies off all supporting documents

Sworn to and subscribed before me on this the _______day of ______________, 2_____.