Massage Therapy Complaint Form

Complaint and Feedback Form

To file an electronic complaint please complete the following information and press submit. Complaints are public information.

ADH recommends that all persons filing complaints that may rise to criminal conduct, consider filing a complaint with the local police department. By submitting a complaint, you may be requested to testify to the violations witnessed in a disciplinary hearing before the advisory committee.

Please submit the complaint when complete or return the completed form to: Arkansas Department of Health, Cosmetology and Massage Therapy Section, 4815 W. Markham, Slot 8, Little Rock, AR 72205 or call 501-682-2168.

NOTE: This information is available under the Freedom of Information Act.

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Complaint and Feedback Form

Type of Business(Required)

Massage Therapist

Massage Therapy Spa/Clinic

Cosmetology Practitioner

Cosmetology Establishment

Body Art/Permanent Cosmetic Artist

Body Art/Permanent Cosmetic Establishment

Complaint Reported By(Required)

First Last

Complaint Reported By Email(Required)

Complaint Reported By Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Complaint Reported By Phone Number(Required)

Date of Occurrence(Required)

Time of Occurrence(Required)

Name of Therapist, Spa/Clinic, Practitioner, or Establishment(Required)

Address of Establishment(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number of Establishment(Required)

Briefly describe the violation:

Programs & Services

Complaint and Feedback Form

Complaint and Feedback Form

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