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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 – complete and mail or email the appropriate forms from the list below.
Email: [email protected]
Mail Address: Vermont Board of Medical Practice, 108 Cherry Street, P.O. Box 70, Burlington, VT 05402
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.
Complaint Forms
| Complaint Form | For full description of concern or complaint. |
| Release of Medical Records Authorization Form | 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 Form | 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. |