Consumer Complaint Form
MEDICAL BOARD OF CALIFORNIA CONSUMER COMPLAINT FORM Please Print or Type PERSON REGISTERING THE COMPLAINT Mr. Ms. Name: ... violations of the laws of the State of California. This authorization shall remain valid for three years from the date of signature.
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www.mbc.ca.govOF CALIFORNIA MEDICAL BOARD Licensing Program 2005 Evergreen Street, Suite 1200 Sacramento, CA 95815-5401 Phone: (916) 263-2382 Fax: (916) 263-2487
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