Complaint Form for Violation of Code of Ethics - Consumer

Complaint Form for Violation of Code of Ethics – Consumer

Submitting an Ethics Complaint-Consumers
Any consumer of the services of a Registered Dietitian or Dietetic Technician, Registered who is concerned with the ethical behavior of the RD or DTR should use the following complaint form.

Please complete all the items on the complaint form (please print), including as much supporting evidence as possible. Please review the ADA/CDR Code of Ethics for the Profession of Dietetics before completing the complaint form. Forward the completed complaint form to Harold Holler, RD, Director, Governance, (ADA, 120 South Riverside Plaza, Suite 2000, Chicago, Illinois 60606-6995) in an envelope marked CONFIDENTIAL.

Please note the deadline for filing a complaint specified in Section "Ethics Cases" (page 5, Code of Ethics) of the procedures for submitting a complaint. If the ethics process goes forward, a copy of the complaint will be sent to the respondent.

Confidentiality procedures will be followed as set forth on page 13, Code of Ethics.  Please keep this matter confidential. Please feel free to contact Harold Holler (800/877-1600, extension 4896) if you have any questions.

  • Consumer Complaint Form
    You can type directly on this form and print it out using the "print form" button in the top right hand corner.  Please Note: All complaint forms must be notarized.
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