Complaint Reporting Form

Your information

(the complainant)

Last name *

First name *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone number *

Member information

(the person you are submitting the complaint about)

Last name *

First name *

Laboratory name *

Laboratory phone number *

Laboratory address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Concern

Please provide all relevant information regarding your concern by describing it below or uploading documentation. We require clear and concise details/summary of what happened, such as the date and time of the incident, the order of events, and the names of witnesses. The CMLTA does not have jurisdiction to investigate concerns about business practices, financial matters, poor customer service, or the manners of the practitioner. These concerns should generally be referred to the owner/manager.

Concern details *

File Upload

Click or drag a file to this area to upload.

File Upload

Click or drag a file to this area to upload.

Please indicate the CMLTA Standard of Practice that was violated. More than one may be selected. *

Standard 1: Professional Accountability
Standard 2: Knowledge Based Practice
Standard 3: Professional Roles
Standard 4: Ensuring Professional Boundaries with Patients and Prevention of Sexual Abuse and Sexual Misconduct
Standard 5: Continuing Competence Program (CCP)
Standard 6: Preventing Female Genital Mutilation
Not Applicable: Code of Ethics was violated

The CMLTA Standards of Practice can be viewed at: https://www.cmlta.org/about-us/standards-of-practice/

Please provide evidence to support the Standard(s) violation by describing it below or uploading a document.

File Upload

Click or drag a file to this area to upload.

Please indicate the CMLTA Code of Ethics that was violated. More than one may be selected. *

Principle 1: Responsibility to the Public
Principle 2: Responsibility to the Profession
Principle 3: Responsibility to Oneself
Not Applicable: Standards of Practice was violated

The CMLTA Codes of Ethics can be viewed at: https://www.cmlta.org/about-us/code-of-ethics/

Please provide evidence to support the Code of Ethics violation by describing it below or uploading a document.

File Upload

Click or drag a file to this area to upload.

Signature: *

Name

We're available to answer your questions

Contact CMLTA

The College of Medical Laboratory Technologists of Alberta (CMLTA) is the regulatory body for Medical Laboratory Technologists (MLTs) employed in Alberta.

Treaty 6

We wish to acknowledge that the land on which the CMLTA office is located is Treaty 6 territory and a traditional meeting ground for many Indigenous people. This is home to the Cree, Blackfoot, and Metis, as it is for the Nakoda, Tsuu T’ina, Chipewyan, and other Indigenous people. Their spiritual and practical relationships to the land create a rich heritage for our life as a community.

Quick Links

Contact Information

301-9426 51 Avenue NW,
Edmonton, Alberta
T6E 5A6

Phone: 780-435-5452
Toll Free: 1-800-265-9351
Fax: 780-437-1442