West Virginia Board of Examiners in Counseling
Complaint Investigation Report
LPC: Investigator:
LPC License No.:
Business Name: Date of Report:
Business Address: Case Number:
Business Phone:
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I. Briefly State Complaint and Alleged Code Violations
II. Briefly State Complainants Supporting Facts
III. Report Method of Investigation
Include names of individuals interviewed, dates of interviews and documents reviewed.
IV. State Investigation Finding(s) & List the Supporting Facts
V. Other
This section is for other information uncovered during the investigation to be reported as necessary.
Signature of Evaluator
Reporting Instructions:
The investigator is instructed to complete the investigation and report providing the WV Board of Examiners in Counseling factual information uncovered during the investigation and impressions without including personal value judgments.