Statement of Complaint Form

The Louisiana Physical Therapy Board (the "Board") is vested with the obligation to regulate the practice of physical therapy in the State of Louisiana through licensure, practice requirements and prohibitions, and disciplinary actions against its licensees. Additionally, the Board is empowered with the authority to seek injunctive relief against unlicensed individuals or entities who violate the Louisiana Physical Therapy Practice Act, LA. R.S. 37:2401 - 37:2425.

In complying with this obligation to regulate the practice of physical therapy, the Board is required to investigate all complaints of wrongdoing which it receives. The Board takes all complaints seriously.

How to File a Compliant

Please complete and submit this online complaint form. You will receive an acknowledgement of receipt from a Board staff member. A panel will be designated to investigate the complaint, which is typically composed of one or more board members, the executive director, investigator and legal counsel. Board staff will keep you informed of progress of the complaint periodically, but you may inquire about the status of your complaint at any time.

Investigation Process

During the investigation, you may be contacted to assist in the investigation by providing additional information. Complaints may be settled informally by the Board without a formal hearing, or with a formal hearing. An investigation may be dismissed if there is absence of adequate, credible evidence or for other reasons which are justifiable for dismissal. When an investigation is dismissed, you will receive a letter explanation for dismissal of the complaint.

Questions or Assistance

If you are uncertain about reporting a complaint and wish to speak with someone to discuss our investigative process in more detail, please contact the Board office at 337-262-1043 or email info@laptboard.org to request a phone call.

Persons with special needs or disabilities may also contact the Board office at the above number or email address for additional assistance in reporting a complaint.

Person Accused of Wrong Doing

AccusedAddress

Format: 99999, numbers only
Format: sample@domain.com.
Format: 123-456-7890.

Description of Wrongdoing

Please be as specific as possible and provide names, dates, times, locations, etc.

Persons with Knowledge of Situation

Please provide names, addresses, and telephone numbers of other persons with knowledge of this situation or who could also provide information.

First Witness Info

The fields below are related to the primary person with knowledge of the situation.

Person with Knowledge Address

Format: 99999, numbers only
Format: sample@domain.com.
Format: 111-111-1111

Secondary Contact Information

Secondary Address
Format: 99999, numbers only
Secondary Contacts
Format: sample@domain.com.
Format: 111-111-1111

Second Witness

The fields below are related to the second person with knowledge of the situation, should you choose to provide a second person in this report.

Witness 2 Address

Format: 99999, numbers only.
Format: sample@domain.com.
Format: 123-456-7890.

Secondary Contact Information

Secondary Contact Address
Format: 99999, numbers only.
Secondary Contacts
Format: sample@domain.com.
Format: 111-111-1111

Relevant Documents

IMPORTANT: If you enter an email address with your contact information, you will receive a separate email from the Board office with a secure upload link to upload any relevant documents you'd like to share with the Board.

If there are any documents in existence such as letter, reports, records, notes, memoranda, etc. which are pertinent to the allegations of wrongdoing please describe them, their identity location above.

Complainant

Complainant Address (No PO boxes)

Format: 99999, numbers only.
Complainant Home or work address?

Complainant Secondary Address

Format: 99999, numbers only.
Home or work address?

Complainant Contact Information

Format: sample@domain.com.
Format: 111-111-1111
Format: 111-111-1111
Format: 111-111-1111
Format: 111-111-1111
Confirm Finalization

The information you are about to submit cannot be edited after it has been submitted. Please review all fields before finalizing your submission.

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