Commonwealth of Kentucky - Attorney General

ATTORNEY GENERALDANIEL CAMERON

Secure Online System

Consumer Complaint Information

If you wish to file a telemarketing or "no-call" complaint, please visit http://nocall.ky.gov.

The information you provide will be used in our effort to resolve your problem and may be shared with the party against which you have complained. It may also be used to enforce applicable state laws. Under Kentucky's Open Records Act, this complaint will be available for public view upon request. However, certain personal information, such as account numbers, is not subject to the Open Records Act.

Please provide as much information as possible.

You may also request a complaint form be sent to you by emailing the Consumer Protection Division or by calling our toll free number at 1-888-432-9257 and selecting option #3. Please leave your name and address and indicate whether your complaint is against a telemarketer, automobile dealer, or other type of business.

If you would like to retain a copy of your complaint for your records, please print this page before clicking Submit.

Ex: 555-555-5555

Ex: 555-555-5555

Character Limit of 1000

Character Limit of 1000

Please upload documents related to your complaint including, warranties, credit card receipts or statements, contracts, advertisements, canceled checks, or photos. Please upload one file under 1MB (jpg, png, bmp or pdf).

AUTHORIZATION TO RELEASE INFORMATION

Electronic Signature

By providing your electronic signature, you authorize that the information submitted on this consumer mediation complaint form is true and accurate to the best of your knowledge.

Authorization to Release Information

Please complete this section only if your complaint involves financial institutions, mortgage/loan concerns, a debt collector, a medical provider or other issues that require a third party authorization. This Is a voluntary release of information and is not required to file a mediation complaint, however in order for the business entity to disclose personal Information with our office, a release is needed.

The undersigned has submitted a consumer complaint and is currently working with the Kentucky Office of the Attorney General through the mediation process and hereby authorizes the company listed below (and its employees) to speak with and discuss my account/loan/mortgage on my behalf with the Kentucky Office of the Attorney General. The parties listed are each authorized to share with the other any and all information concerning my account, including but not limited to, financial Information, without furĀ­ther authorization and until this matter is closed by the Office of the Attorney General or the Authorization is revoked.

HIPAA Privacy Authorization

Authorization for Use or Disclosure of Protected Health Information

By providing your electronic signature, you authorize the Healthcare Provider listed below to use and disclose your protected health information to the Office of the Attorney General for use in your consumer mediation complaint.