PFR OLR Complaint Form

Complaints & Investigations Division
35 State House Station
Augusta, Maine 04333-0035
Telephone (207) 624-8660
TDD(207) 624-8563
FAX (207) 624-8637

Provided is an occupational/professional license complaint form.

In the event that you need to be contacted regarding your complaint, please provide the following information and return this page with your complaint form.

COMPLAINANT INFORMATION

Todays Date:(MM/DD/YY)
Title: Mr. Ms. Mrs.
Last Name:  
First Name: 
Middle Init: 
Address:    
City:       
State:      
Zip Code:   
Country:    
Phone Number (day):  Ext 
Phone Number (eve.):
Fax Number: 
EMAIL:

LICENSEE COMPLAINED ABOUT

Licensing Board: 
Title: Mr. Ms. Mrs.
Last Name:  
First Name: 
Middle Init: 
Address:    
City:       
State:      
Zip Code:   
License number or type:







Clearly Explain your Complaint:



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