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Complaint Form
NAME:
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DATE:
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+
Email address
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Are you a Board certified Pharmacist?
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Yes
No
Pharmacy Specialty
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Ambulatory Care
Cardiology
Critical Care
Geriatric
Infectious Disease
Nuclear
Nutrition Support
Oncology
Pediatrics
Pharmacotherapy
Psychiatric
N/A
Complaint Category
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Application Process
Certificates (not received, damaged, name issue)
General issue
Misuse of marks/logos
Policy Issue
Recertification Issue
Report unauthorized use of BPS credential
Website (access, ease of use, content)
Please provide detailed description of the complaint
*