Public Complaint Form

  • NEVADA STATE BOARD OF OPTOMETRY

    • WILLIAM F.HARVEY, O.D.
    • Board President
    • CHEN K.YOUNG, O.D.
    • Board Member
    • SHERESE SETTELMEYER
    • Public Board Member
    • MARIAH L. SMITH, O.D.
    • Board Member
  • COMPLAINT AGAINST A LICENSED OPTOMETRIST

  • Individual filing Complaint
  • (Doing Business As)
  • You must state the facts underlying your complaint with particularity and offer a statute or regulation that you feel has been violated. You must also provide a minimum level of credible evidence to support your claims, or they will be rejected as having faied to me the minimal standard to proof.

  • I authorize the Nevada State Board of Optometry to provide a copy of this Complaint to the subject of this Complaint and to obtain a copy of any of my patient records in the Doctor’s possession.

  • being first duly sworn, deposes and states: I have read the foregoing Complaint and know the contents thereof; that the contents are true of my own knowledge, except as to those matters stated upon information and belief, and as to those matters I believe it to be true.

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