The Vermont Board of Medical Practice investigates complaints of unprofessional conduct, and may issue reprimands; or revoke, suspend, or place conditions on professional licenses and certifications, or take action where appropriate to protect public health and safety. If you have a concern about a medical professional licensed by the Board – print out, complete and mail in the appropriate form from the list below. To proceed with an investigation, the complaint form and Authorization for Release of Medical Records must be received by the Board. Call 802-657-4220 with questions.
If you require immediate assistance or have questions about legal issues pertaining to health care, you may contact Vermont Legal Aid, Health Care Advocacy at 1-800-917-7787 or vist the website for more information.
|Complaint Form||For full description of concern or complaint.|
|Authorization for Release of Medical Records Form BMP-ComplaintForms-AuthorizationReleaseMedicalRecords.pdf||For your own medical records.|
|Consent For a Child Form||For medical records for your child or a child for whom you are guardian.|
|Holder of Power of Attorney||For medical records of a person who is living for whom you have Power of Attorney.|
|Personal Representative Form||For medical records of a person who is deceased / you were able to participate in health care and had a Power of Attorney, were named in an Advanced Directive, or as a guardian or conservator.|
|Executor of the Estate Form||For the medical records of a patient who is now deceased and you are the Executor of the Estate. This title varies among states, and may also be personal representative, administrator, trustee, etc. depending upon the location of the estate.|