Connecticut Department of Public Health, Practitioner Investigations Unit

How the official source says to file

• Use the petition form for the practitioner. Provide patient and provider details, dates, a detailed factual account, other treating providers and witnesses; attach supporting copies.
• Sign and date the petition and complete the records release, including the patient or representative and witness signatures. Guardians should attach court documents. The stated notarization requirement is for physicians and physician assistants; it is not stated for dental complaints.
• Email the packet to DPH.PLISComplaints@ct.gov, fax 860-707-1916, or mail Practitioner Investigations Unit, MS#12HSR, P.O. Box 340308, Hartford, CT 06134-0308. Call 860-509-7552 to request a paper form.

Supporting guidance: Connecticut DPH: Reporting a Complaint ↗Connecticut DPH: petition and release ↗

What this route may not provide

DPH acts against professional licenses and cannot obtain compensation or fee refunds. Ordinary fees, billing practices and administrative disputes generally fall outside this process. Supply specific clinical or professional facts; a complaint about the company does not automatically establish misconduct by its clinicians.

Supporting guidance: Connecticut DPH: Reporting a Complaint ↗Connecticut DPH: complaint FAQ ↗

Do not guess about confidentiality

The form requests the complainant’s identity and signature; anonymous acceptance was not established. DPH warns that complaints and supplied information may be disclosed under Freedom of Information laws. The signed release permits sharing records with the subject practitioner and legal representative.

Supporting guidance: Connecticut DPH: Reporting a Complaint ↗Connecticut DPH: petition and release ↗

Acknowledgment expected within two weeks

The webpage says to expect written acknowledgment within two weeks of receipt and follow up if none arrives. A filing deadline was not established by this check; ask promptly. Receipt acknowledgment is not a promise of investigation completion.

Supporting guidance: Connecticut DPH: Reporting a Complaint ↗

What may happen after filing

DPH investigates matters within its professional-licensing authority. Any resulting action is administrative and concerns the provider’s license. The checked instructions do not promise a fixed investigation duration or a particular outcome.

Supporting guidance: Connecticut DPH: Reporting a Complaint ↗Connecticut DPH: complaint FAQ ↗

Prepare a reviewable submission

State the concern you want reviewed, give a short chronology and factual consequences, and explain your request. Keep supporting records and follow the receiving authority’s instructions before attaching or sending them.