File a Concern / Complaint

Have a concern or complaint regarding a respiratory therapist? Submit your concern online in confidence to the Registrar. (For assistance or difficulty completing the form, please contact the Registrar and Deputy Registract by clicking here or at [email protected] and [email protected])

Contact Information

First Name:(*)

Please enter your first name.

Your Email(*)

Please let us know your email address.

Last Name:(*)

Please enter your last name.

Telephone:(*)

Please enter your phone number.

Civic Address:(*)

Please enter your full civic address.

Details of Concern

Number of Respiratory Therapists Involved:(*)

Please select the number of respiratory therapists involved in the incident.

Respiratory Therapist's First Name:(*)

Please enter the first name of the Respiratory Therapist involved.

Second Respiratory Therapist's First Name:(*)

Please enter the first name of the second Respiratory Therapist involved.

Third Respiratory Therapist's First Name:(*)

Please enter the first name of the third Respiratory Therapist involved.

Location of the Incident:(*)

Please enter the location of the incident.

Respiratory Therapist's Last Name:(*)

Please enter the last name of the Respiratory Therapist involved.

Second Respiratory Therapist's Last Name:(*)

Please enter the last name of the second Respiratory Therapist involved.

Third Respiratory Therapist's Last Name:(*)

Please enter the last name of the third Respiratory Therapist involved.

Date of the incident(*)

Please select the date the incident occurred.

Description of the incident(*)

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Please describe the incident.

Please prove you are human.(*)

Please prove you are human.

File a Concern / Complaint

Contact Information

Details of Concern

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