The intent of the supervisor complaint process is to provide a place to file a complaint on a Supervisor / CPCS. Every effort is made to keep all information confidential.

The Ethics Committee provides remediation options.

*The Ethics Committee has no authority to settle business practices/billing/fee disputes.

You may seek legal counsel or a remedy in the civil court arena for issues dealing with business practices/billing/fee disputes is an option.

Only the GA Composite Board of PC, SW, MFT and/or the Ga Attorney General has authority of licensing.

Board rule 135-7 Code of Ethics requires licensee to report.

We strongly encourage anyone with a formal complaint against a supervisor (CPCS, ACS, etc.) to take the necessary steps of filing a complaint with the GA Composite Board and/or NBCC

First Name *

Last Name *

Phone *

Email *

Date of Filing Complaint *

Supervisor/Supervisee Information

(Alleged Violator)

First Name of the Person You Are Reporting *

Last Name of the Person You Are Reporting *

Email Address of the Person You Are Reporting *

Phone Number of the Person You Are Reporting *

Address of the Person You Are Reporting

City

State

Postal Code

Beginning Date of Supervisor/Supervisee Relationship

End Date of Supervisor/Supervisee Relationship

Complaint and Supporting Information/Documentation

Please provide as much information as possible to assist in the successful resolution of your complaint. You may also wish to download a copy of the relevant law and rules from the home page of the GA Composite Board of PC, SW, MFT. When possible list the section of rules in violation (Code of Ethics Rule 135-7 section...) Or CPCS Code of Ethics.

Attach documentation such as emails, letters, notes, charts, documents, records; also, names, addresses, and phone numbers of others who may have information about the alleged violations, etc.

Complainant's Relationship to Violator *

Has This Been Reported to the Licensing Board? *

Yes

Dates of Violation

Details of Complaint *

Supporting Documents

eSign of Complainant *

Clear