Reproductive Rights Complaint Form

* Required Information

1 Your Information

*Do you wish to submit your complaint anonymously?

Yes

2 Information about the alleged violator (business, entity, or individual(s) against whom you are filing this complaint)

*Alleged violator's name:

Alleged violator's address, if known:

City:

*State:

Zip: invalid

Alleged violator's phone number, if known:

Alleged violator's e-mail address, if known: Invalid

Alleged violator’s web site, if known:

List any additional businesses, entities, or individuals (alleged violators) you are filing this complaint against and their contact information:

Date of incident:

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*Please select one (or more) of the following choices that best describes the basis for your complaint:

3 Public Record Disclosure and Acknowledgement

* Your Complaint will become a public record. For this reason, please do not include sensitive personal information, including personal healthcare information.

By selecting YES below, I acknowledge that my complaint and attachments, once submitted, become public records and may be disclosed to others in response to a Public Records Request. By selecting NO below, I am choosing not to submit my complaint.

If you have selected NO below because you do not wish to submit a written complaint, you can instead call 1-800-551-4636 (in Washington); 206-464-6684 (outside of Washington); or 1-800-833-6388 (relay service). You can also leave an anonymous complaint by selecting YES and indicating that you wish to submit your complaint anonymously in the first question in section 1.

To learn how we safeguard your personal information, please read our Privacy Policy.

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Washington State

Attorney General

1 Your Information

2 Information about the alleged violator (business, entity, or individual(s) against whom you are filing this complaint)

3 Public Record Disclosure and Acknowledgement