Texas Department of Licensing and Regulation

COMPLAINT FORM

NOTICE
If you wish to file your complaint anonymously to ensure your identity is not revealed, you must leave section ‘B’ (You, as the complaining party) blank.
If the complaining party files anonymously they will not receive automated status updates.

Filing a Podiatry complaint online is not an option at this time. For your convenience we have included this link to the complaint form that may be printed. After completing the printed form, please send it along with supporting documentation to TDLR, Enforcement Division.

Please do not send original documents. Electronic files may be submitted on CD or DVD. All documents and media you send us will be scanned, electronically saved, and then destroyed.

Submitted documentation can only be received via fax number (512)539-5698, USPS mail to TDLR, Enforcement Division, P.O. Box 12157, Austin, Texas 78711, or hand delivery to TDLR at 920 Colorado, Austin, Texas 78701.

In order for the Texas Department of Licensing and Regulation to pursue an investigation of your Podiatry complaint please provide all documentation and information related to your complaint. If your complaint does not contain enough information for the Department to make a determination that a violation has occurred, your complaint may not be opened for investigation.

When completing section D of this form, important information to support your complaint may include:

  • complete explanation of your complaint
  • client/patient name, address and phone number if you are filing complaint on behalf of someone other than yourself
  • if you are filing complaint on behalf of someone other than yourself, include your relationship to the client/patient
  • age of client/patient if a minor
  • full name, address, phone and license/certificate number of podiatrist/facility
  • dates podiatrist provided care
  • name, address and telephone number of any witness who may have information about the alleged violations
  • date medical attention was sought, name of attending medical personnel, diagnosis and treatment
  • if medical attention was sought, the name and address of the facility
Documentation to support your complaint may include: (Please do not send original documents. All documents you send us will be scanned, electronically saved, and then destroyed.)
  • advertisement/business cards
  • receipts of payment made
  • photographs/videos
  • written statements made by any witness you identified in your complaint
  • medical charts, records and diagnosis, by anyone who provided medical treatment (Doctor, etc.)
  • all documentation provided by the podiatrist
Please submit additional documentation in support of your complaint to the Department by fax (512)539-5698 or mail to TDLR, Enforcement Division, P.O. Box 12157, Austin, Texas 78711. Please do not send original documents. All documents you send us will be scanned, electronically saved, and then destroyed. Submitted documentation can only be received via e-mail, fax or regular main. Attachments cannot be submitted with this link.

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