Cosmetology Complaint Form

Complaint and Feedback Form

I understand that a copy of this complaint submitted to the Arkansas Department of Health, Cosmetology, Body Art, and Massage Therapy Section may be provided to the party I am complaining against in an effort to resolve the matter. I authorize the party against which I have filed this complaint to communicate with and provide information to the Arkansas Department of Health, Cosmetology, Body Art, and Massage Therapy Section. I also understand that my complaint may be referred to other agencies. I understand that the Department does not represent individuals in private disputes (Refunds). I am filing this complaint to notify the Department of the activities of this party and to request any assistance that may be available, including attempted resolution of my complaint or referral to another appropriate entity. I acknowledge that by submitting this complaint, the Department will keep a record of it, and it may be considered a public record subject to disclosure under the Arkansas Freedom of Information Act (FOIA). Under FOIA, any information sent to the Department may be released to the public upon request. If someone requests a copy of this complaint, they have the legal right to obtain it, including my name and any information I have provided. I further understand that if this matter results in a formal hearing, I may be required to testify, and therefore I cannot remain anonymous.

Type of Business(Required)
Complaint Reported By(Required)
Complaint Reported By Address
MM slash DD slash YYYY
Time of Occurrence(Required)
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Address of Establishment(Required)

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