ADHS Licensing Complaint Submittal Form

Online Complaint Submittal Form - Long Term Care Licensing

The Division of Licensing Services Bureau of Long Term Care Licensing provides this Online Complaint Form which allows anyone with knowledge or concerns about a suspected rule violation to submit a complaint through this web page. A complaint is a suspected violation of Arizona state rules and/or statutes governing the operations of licensed Long Term Care Nursing Homes and Intermediate Care Facilities for the Developmentally Disabled (ICF/IID).

Please review the following prior to submitting the complaint allegation.

Complaint Frequently Asked Questions (FAQs)

When filling out this form, information that is required is indicated by a red asterisk (*). Click "Start" to begin complaint.