Illinois Department of Financial & Professional Regulation Illinois Department of Financial & Professional Regulation
 
Manuel Flores, Acting Secretary  
Pat Quinn, Governor
www.idfpr.com
www.idfpr.comAgency Quick Links
IDFPR Home Page
Información Disponible En Español
License Look Up
Physician Profile
License Renewals
Latest News
Discipline Information
Consumers
Professionals
Information About
IDFPR
Banking
Non-banking Financial Institutions
Professional Regulation
About IDFPR
Contact Information
General FAQs
Boards & Committees
Search IDFPR.com
Pay Our Bills.Illinois.Gov
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 February 2014 Monthly New License Report
IDFPR December 2013 Discipline Report
State Regulators Offering Professional Exam in Chinese
Illinois Regulators Accept Multi-state Mortgage Servicer Settlement
State Urges Caution towards Medical Cannabis Clinics
State Regulators Warn that Colored Contact Lenses Could be Dangerous this Halloween
Governor Quinn Launches Get Covered Illinois - The New Online Marketplace for Affordable Health Care across Illinois
More....
Division Features
License Look Up
License Renewal
Illinois Roofers List
License Reprint/Address Change
Acts & Rules
Appraisal Information
Division Overview
Fingerprint Vendor Agency List
Fingerprint Results
FY14 Committee/Board Schedule
FY13 Committee/Board Schedule
CCA Form for Healthcare Workers
Monthly New License Report
Mortgage Relief Project
Mortgage Fraud Task Force
Non-Binding Advisory Opinion
Number of Active Licenses
Physician Profile
Proposed Rules
Real Estate Division
Related Links
File a Complaint
External Links
State Features
Illinois AMBER Alert
Illinois Business Portal
Illinois Veterans Care
Illinois workNet