If you would like to talk to someone about the care you received from an optometrist, the optometrist’s conduct, or the College’s complaint process, please contact the College at:
- Tel: 416-479-9295
- E-mail: email@example.com
The College has no authority to deal with monetary issues, direct the optometrist to provide any kind of monetary compensation, or make a refund. The College’s complaint process deals with professional conduct, competency or capacity of registered optometrists in Ontario.
The information you provide on this form will only be used for the purpose of investigating and deciding on your complaint. The College will not share the information outside of the investigation, and discipline/appeal process, if applicable.
To initiate a formal complaint about an optometrist, please complete this form and submit it to the College.
How to Submit (3 options):
- Submit this online form;
- Email the completed PDF form to firstname.lastname@example.org; or
- Mail the completed form to:
Coordinator, Investigations and Hearings
College of Optometrists of Ontario
65 St. Clair Ave E, Suite 900
Toronto, ON M4T 2Y3
COMPLAINT FORM - COMPLAINANT & PATIENT INFORMATION
D. Details of Complaint
Please provide a brief outline of your concerns, including the following:
Separate multiple dates with commas ie. YYYY-MM-DD, YYYY-MM-DD, YYYY-MM-DD
1500 characters available, this field is mandatory.
1500 characters available
Please upload any supporting document(s) relevant to your concern(s). Please include above in the text boxes an explanation of how each relate to your concern(s).
Only certain document types are accepted (.pdf, .doc, .docx, .jpg, .jpeg, .bmp, .tiff, .gif, .m4a, .flac, .mp3, .mp4, .wav, .wma, .aac, .avi, .mpeg, .mpg)
E. Consent & Acknowledgement
Please note: If you are submitting a complaint about the care you received or if the patient is a minor child and you are the parent / guardian, please complete and sign the consent form. If you are submitting a complaint on behalf of another patient, please make sure the patient has completed and signed the form after carefully reviewing it.
As part of our investigation, we may need to obtain your relevant personal health information including your patient record from the optometrist(s) you complained about, from health care practitioners who treated you and/or from facilities at which you were treated related to the optometric care you received. For this purpose, we ask that you complete the following form.
consent to the release of my personal health information to the College of Optometrists of Ontario by the following:
A. The optometrist you are complaining about
*If you wish to complain about additional optometrist(s), please attach additional consent pages as needed and sign each page.
B. Other optometrist(s) (who are not the subject of my complaint), ophthalmologist(s), health care practitioners, and facilities who have treated me related to the optometric care I received
*If additional optometrist(s), ophthalmologist(s), health care practitioner(s), and facilities were involved, please attach additional consent pages as needed and sign each page.
The College has a duty of confidentiality with respect to all information obtained in the course of its investigation. However, the College may share some or all of your personal health information with the optometrist(s) who are the subject(s) of the complaint.
If either you or the optometrist(s) appeal the College’s decision, medical information and other information collected during the investigation must be disclosed to the Health Professionals Review and Appeal Board, which is a public forum.
I understand the purpose for which this consent is given. I understand that I can withdraw or limit my consent at any time by providing written notice to the College. I understand that I can refuse to sign this consent form. However, I understand that the College may proceed in the absence of patient consent and reach a decision without having the benefit of this information.
By clicking “Submit” I hereby confirm that I am the person identified on this form as filing this complaint.
Note: Please check your junk email folder if the confirmation email does not appear in your inbox.