Complaint Form Complainant DetailsFull Name *NRIC/FIN/Passport No *Contact NumberEmail AddressResidential AddressPatient Details (Complete only if different from complainant)Full Name *NRIC/FIN/Passport No *Relationship to ComplainantPractitioner DetailsName of Practitioner/TherapistClinic/Practice NameClinic AddressDates of Visit / TreatmentNature of ComplaintProfessional MisconductNegligence / Unsafe PracticeUnethical BehaviourInappropriate Conduct or CommunicationFraud or MisrepresentationBreach of APAS Code of ConductOtherDescription of IncidentProvide a detailed account of the incidentSupporting Documents AttachedPlease tick attached documentsReceiptsMedical ReportsPhotographsCorrespondenceOtherDated 01/31/2026 my complaint letter contains facts that are true and accurate. The following allegations are made against the practitioner. I affirm that all supporting documents submitted are genuine and unaltered. And I make this solemn declaration conscientiously believing the same to be true.DeclarationI declare that the information provided is true and accurate to the best of my knowledge.SignatureChoose FileNo file chosenDelete uploaded fileDateName of the complainant Submit
