Complaint Form

NAME: *

DATE: * +

Email address *

Are you a Board Certified Pharmacist? *

Yes

No

Are you in a recertification extension year? *

Yes

No

Pharmacy Specialty *

BPS Credential Number

Eligibility ID or Exam ID (examinees, if applicable)

Complaint Category *

Please provide a detailed description of the complaint *

Supporting Documentation as applicable

Scheduling or Displacement Issue	CE Provider Issue	Exam Content Relevance/Clarity
Exam Time Allotment	Testing Center Issue	Application Process
Certificates (not received, damaged, name issue)	General issue	Misuse of the BPS Marks/Logos
Certification Policy Issue	Recertification Policy Issue	Report Unauthorized Use of BPS credential
Website Issue (access, ease of use, content)