Report A Violation

PMA licensees are licensed as spiritual providers and are expected to conduct their practices and services with integrity and in a manner that would be expected of a spiritual provider. If you feel that a licensee has acted in any manner that is inconsistent with the conduct reasonably expected of a spiritual provider, or has violated the terms of an Agreement for Wellness Services he or she has with you, the licensee may be in violation of his or her license regulations and we would appreciate your letting us know.

The PMA does not mediate complaints you may have about services you have received from a PMA licensee. Please refer to the Agreement for Wellness Services or other agreement (s) you have with the licensee for instructions on filing or settling a dispute or complaint.

Your Information:

Your Name

Your Address *

Street address

Address Line 2

City

State / Province / Region

Postal Code

Country

Email*

Phone number

Best Phone to Reach You

Date of Birth

Year/Month/Day

INFORMATION ON THE PMA LICENSEE YOU ARE REPORTING

If a question does not apply or you do not know the answer, enter N/A or "I don't know". Do not leave any question blank.

Licensee Name

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Licensee Email

Licensee Phone Number

Please describe what the licensee has done that you feel violates ministerial standards*

Please tell us the date or dates this occurred?*

If you are now, or have been a client in the past, please explain why you sought services?*

Describe any harm that has come to you or another as a result of the incident you are reporting*

In addition to this report, if you intend to take other action such as seeking monetary compensation, please explain.

Please describe any additional information you feel is important.*

Oath & Permission

Please acknowledge your agreement with the following two items by placing a check by each.

I promise that this is report and all information herein and that I may provide later is valid, true and correct to the best of my knowledge.*

I grant the PMA permission to contact me to review/investigate this reported violation.*