Instructions for Submitting a Complaint

Instructions for Submitting a Complaint

INSTRUCTIONS FOR SUBMITTING A COMPLAINT

  1. Review ALL documents to confirm that your complaint falls within the Grounds for Professional Discipline
  2. Enter your information online at: Submitting a Complaint. This must be done before submitting your detailed complaint via email.
  3. Complete all sections of the following “Complaint Form for Professional Ethical Violations”
  4. Be sure to enter your full name on the electronic signature lines to confirm you understanding and agreement with the requirements. Forms without your name entered will not be accepted.
  1. Save your form as a Word document as follows: YourLastName-YourFirstName_Complaint.doc (e.g., Smith-Jane_Complaint.doc)
  1. Email the completed form with any supporting documentation to:

Complaint Form for Professional Ethics Violation

Please note the following: Before filling out this complaint form, refer to the IAYT interim policy, “Grounds for Disciplinary Action,” to make sure that your complaint presents a basis upon which IAYT may take disciplinary action; there are many types of complaints that do not fall under IAYT’s purview and therefore cannot be addressed. Note also that IAYT will only act upon a formal complaint concerning an IAYT member, and will not act upon an anonymous complaint. As part of an investigation, IAYT will provide any individual or entity who is the subject of the complaint an opportunity to respond. IAYT reserves the right, however, to withhold the name of a complainant from the person who is the subject of the complaint if the complainant is in a situation where there is still an ongoing relationship and therefore the possibility of retribution.

1. Complainant Information

First Name: / Last Name:
Home/Personal Phone: / Work Phone:
Street Address: / City/Town:
State/Province: / Zip/Postal Code:
Email address: / Country:

2. Who or what organization do you believe committed this violation?

Person/Organization Name:
Street Address: / City/Town:
State/Province: / Zip/Postal Code:
Country: / Email address:

3. Nature of Complaint (Check all that apply):

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False, Deceptive or Misleading Advertising or Information

Boundary Violations/Sexual Misconduct

Violating Confidentiality

Fraudulent/Negligent Billing or Recordkeeping

Practicing While Impaired or Otherwise Unfit to Practice

Causing Harm or Injury/Incompetent Practice

Providing Treatments without Informed Consent

Other (Describe):

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  1. If applicable, outline what steps you have taken to address the complaint—including whether the complaint has been lodged elsewhere—and what was the outcome of these steps.
  1. Please state clearly what you would like this person or organization to do to address your complaint:
  1. Please clearly explain what action you would like taken, or what assistance you want from IAYT:
  1. State any other suggestions on how to resolve the complaint:

In a separate document briefly describe the facts of your complaint. Please attach a clear and concise description of the nature of your complaint (complaint letter).Include facts, reports, dates, court documents, legal documents, medical documents and any other documents that will support your complaint.

(NOTE: IAYT reserves the right to address a complaint in whatever way it considers in accordance with its policies and appropriate to the situation.)

AUTHORIZATION FOR RELEASE:

Iunderstandthat by signing this authorization statement, I give my consent to theInternational Association of Yoga Therapists to releasetheserecordsand this informationforthepurposeofinvestigationandproceedingsinvolvingissuesrelatingto thecomplaint I havesubmitted to IAYT.Ialso consent to thereleaseoftheserecordstootherregulatory agencies,as appropriate,foruseinaninvestigationorproceeding againstthepractitioner or teacher whoisthesubjectofmy complaint.

Complainant Name (Please enter your full name - this serves as an electronic signature)

I HEREBY ATTESTTHATTHE FOREGOINGINFORMATION ISTRUE TOTHE BESTOF MY KNOWLEDGEANDBELIEF,ANDTHATIAMCOMPETENTTOMAKETHESESTATEMENTS.

______

Dateof Complaint

Complainant Name (Please enter your full name – this serves as an electronic signature)

The IAYT Ethics and Disciplinary Review Panel (“EDRP”) hastheauthoritytoinvestigate complaintsreceivedandtoimposesanctionsonIAYT members.PleaserefertotheIAYTProceduresforUpholdingProfessional Conducttounderstandtheprocessforevaluating complaintsreceivedagainstIAYT members.

Ifyouhavequestionsaboutthecomplaintprocess,contactJohn Kepner, Executive Director,.

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