Louisiana Physical Therapy Board

Statement of Complaint Form

The Louisiana Physical Therapy Board (the "Physical Therapy 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 Physical Therapy 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 - 37:2424.

In complying with this obligation to regulate the practice of physical therapy, the Board is required to investigate complaints of wrongdoing which it receives. Please be assured that the Physical Therapy Board takes all complaints seriously. In order for the Physical Therapy Board to review this matter it will be necessary for you to complete the Statement of Complaint and submit it to the Physical Therapy Board office as set forth in the form. When your complaint is entered in our systems, you will receive an acknowledgement from us and we will keep you informed of progress of the complaint from time to time.

If the allegations of wrongdoing are sufficient to warrant an investigation, the Board will proceed with investigating the matter. You may be asked to assist in the investigation by providing additional information. In the event the investigation concludes that the allegations are sufficient to necessitate further action by the Physical Therapy Board, the complaint may be pursued informally and/or formally in accordance with the Rules and Regulations promulgated by the Board.

Persons with special need or disabilities may contact the Physical Therapy Board office, 337-262-1043, for assistance to meet those needs in reporting a complaint.

Person Accused of Wrong Doing

Description of Wrongdoing

Facts of Alleged 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.


Complainant

Physical Address (No PO boxes)