Important: Upon submission of the electronic Complaint form below, the Complainant must print and sign the Complaint form and mail the original Complaint to the Panel. If the signed Complaint is not received following the electronic submission, the Panel will not accept the Complaint. Signature photocopies will not be accepted.

What you will need

  • Acrobat Adobe Reader
  • Printer

Part One: Complainant Information

First Name: (Required)
Last Name: (Required)
Organization:
Florida Bar Number:
Street Address: (Required)
City: (Required)
State: (Required)
Zip Code: (Required)
Phone Number: (Required)
E-mail Address: (Required)
You are a: (Required)


Does this complaint pertain to a matter currently in litigation? (Required)


Part Two: Respondent Attorney Information

First Name: (Required)
Last Name: (Required)
Organization:
Florida Bar Number:
Street Address:
City:
State:
Zip Code:
Phone Number:
E-mail Address:


Part Three: Facts/Allegations

(Required)











Incident Date: (Required)
RadDatePicker
RadDatePicker
Open the calendar popup.


Standards Implicated: (Refer to Exhibit A)
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The specific incident I am complaining about is: (Required)
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Part Four: Witnesses

The witnesses in support of my allegations are (include name, address, and telephone number for each witness):
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Under penalties of perjury, I declare that the foregoing facts are true, correct, and complete.
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