Complaint Form

In order to ensure the receipt of comprehensive details, the Saskatchewan College of Pharmacy Professionals requests the completion of this Complaint Form. Please complete all relevant information.

By completing this Complaint Form you:

1. Acknowledge that you are lodging a written formal complaint and understand that it is the policy of the College to investigate all written formal complaints; and

2. Give permission to the College to access your pharmacy records and request and receive copies of all medical and pharmacy related records related to the complaint; and

3. Give permission to the College to discuss and/or release part or all of the Complaint Form and all supporting documentation with any person(s) named in the complaint, or any person(s) deemed necessary in the investigation of the complaint; and

4. Certify that the details and information provided are true, accurate and complete to the best of your knowledge.

If you have any questions concerning the above, require assistance, or would like to speak with College staff before completing this Complaint Form, please contact the College office by phone at 306-584-2292 or email complaints@saskpharm.ca

Click here if you would prefer to print a PDF version of the Complaint Form and complete the form by hand.


Please Note: When lodging a complaint on behalf of another person whom you do not have legal authority to consent to the release of his/her personal health information, the College must contact him/her directly to obtain consent.
Mailing Address
ALLEGATION DETAILS
Pharmacy Address
NATURE OF COMPLAINT
Please check all that apply. For Medication Errors please also fill in all of the details below.
If available, please provide the following details from the Prescription Label below:
1. Prescription Number
2. Date of Issue
3. Drug Name
4. Physician’s Name
5. Pharmacist’s Initials
6. Directions
7. Pharmacy Name, Address, Phone Number
Please use your own words to describe the complaint.
If preferred, you may also prepare the written narrative of your complaint in PDF or DOC file format and attach it below. Please also provide any supporting documentation; this may include things such as photographs of medication, prescription containers/vials, receipts or anything else that you believe supports your complaint.
Please attach any supporting documentation here. (PDF or DOC file format only – each file should not exceed 2MB)
What is your expectation in bringing this complaint? (1000 characters max)
I ACKNOWLEDGE that it is the policy of the Saskatchewan College of Pharmacy Professionals to investigate all written formal complaints. I understand and accept that by submitting this Complaint Form that I am lodging a written formal complaint which the College will investigate.
I CONSENT to the use of the information contained in this Complaint Form by the authorized recipient, the Saskatchewan College of Pharmacy Professionals, its affiliates and employees, who are relieved of any responsibility of liability resulting from use of the information. I give permission to the College to access my pharmacy records and request and receive copies of all medical and pharmacy related records related to the complaint. I give permission to the College to discuss and/or release part or all of the Complaint Form and all supporting information to any person(s) named in the complaint, or any person(s) deemed necessary in the investigation of the complaint. I confirm that all details and information provided herein by me are true, accurate and complete to the best of my knowledge.

SASKATCHEWAN COLLEGE OF PHARMACY PROFESSIONALS