New Jersey State Board of Medical Examiners
Online Complaint Form
Please be advised that this complaint form, along with any supporting documents that you provide to us, will be handled confidentially throughout the time that the Board investigates the allegations you have made. The document(s) will thereafter continue to be considered "confidential" if the Board concludes that there is no cause for action against the physician about whom you have complained. If the Attorney General determines that an enforcement action should be initiated, the document(s) you have supplied may be needed as evidence, and you may need to testify.
If a disciplinary action is taken against the physician about whom you have complained, based in part or in whole upon your complaint, then your complaint will be considered to be a "government record" and may be disclosed in response to a request made pursuant to the Open Public Records Act ("OPRA"). However, records relating to an individual's medical, psychiatric or psychological history, diagnosis, treatment or evaluation are not "government records" subject to public access pursuant to OPRA, and accordingly, references to your name and other identifying information may be removed, if deemed necessary, from any documents produced pursuant to an OPRA request.
If you would rather mail in your form you can download it by clicking here.