Illinois Department of Financial & Professional Regulation Illinois Department of Financial & Professional Regulation
 
Bryan A. Schneider, Secretary  
Bruce Rauner, Governor
www.idfpr.com
www.idfpr.comAgency Quick Links
IDFPR Home Page
Military Families
License Look Up
Physician Profile
License Renewals
Latest News
Mandatory State's Attorneys Reports
Medical Cannabis Program
Discipline Information
FOID Mental Health Reporting
Consumers
Professionals
Information About
IDFPR
Banking
Non-banking Financial Institutions
Professional Regulation
Real Estate
About IDFPR
Contact Information
General FAQs
Boards & Committees
Search IDFPR.com
State of Illinois Appointments
State of Illinois
Agencies, Boards & Commissions
Professional Regulation Complaint Intake Form
Department of Financial and Professional Regulation
Division of Professional Regulation State of Illinois
Complaint Intake Form

COMPLAINANT INFORMATION:

Please Note:

If more information is needed, you will be contacted via e-mail or telephone.
An acknowledgement letter will be sent to the address you give here.


Your First Name: Your Last Name:
Mailing Address 1: Mailing Address 2:
City: State:
Zip:    
Your E-mail Address: *
Day Telephone No: (as 999-999-9999) *
Evening Telephone No: (as 999-999-9999)

YOUR COMPLAINT IS AGAINST (RESPONDENT) :


Professional's First Name: Professional's Last Name or Name of Business*
   
Select the profession:   *
Street address (1st line): *
Street address (2nd line):
   
City* State:
Zip code: * Telephone No:(as 999-999-9999) *
Date Event Occurred:(as 99/99/9999) * County Where Occurred:    *
   

BRIEFLY DESCRIBE YOUR COMPLAINT :


(NOTE: Limit 3,000 characters)
 

DFPR RSS Feeds IDFPR Latest News
IDFPR July 2015 Enforcement Report
Illinois Registers First Medical Cannabis Dispensary
Illinois Announces Signing of Cooperative Agreements for the Supervision of State-Chartered Credit Unions
Williamson County, IDFPR Investigate Suspended Pharmacy
IDFPR Division of Banking Charters New Bank
Streamlined Nursing Licensure Verification Begins Today
Third-Party Payment Processors No Longer Require Money Transmitter Licensure in Illinois
More....
Division Features
License Look Up
License Renewal
Illinois Roofing Contractors List
License Reprint/Address Change
Acts & Rules
Appraisal Information
Division Overview
Fingerprint Vendor Agency List
Fingerprint Results
FY16 Committee/Board Schedule
FY15 Committee/Board Schedule
CCA Form for Healthcare Workers
Mortgage Relief Project
Non-Binding Advisory Opinion
Application to Classify Records as Confidential
Number of Active Licenses
Physician Profile
Proposed Rules
Division of Real Estate
File a Complaint
External Links
State Features
Illinois AMBER Alert
Illinois Business Portal
Illinois Veterans Care
Illinois workNet