Madhya Pradesh Medical Council

Government of Madhya Pradesh

Complainant's Info

Full Name of the Complainants *

Title *

First Name *

Middile Name

Surname *

Full Postal Address *

Address *

City *

District *

State *

Pin *

Mobile Number *

Email *

Doctor's Info

Full Name of the Doctor *

Title *

First Name *

Middile Name

Surname *

Full Postal Address *

Address *

City *

District *

State *

Pin *

Mobile Number *

Email *

MPMC Registration Number *

Complaint

Nature of the Complaint

Allegations in Points *

Upload Complaint (pdf only must be less than or equal to 2mb.) *

Upload notarized Affidavit (pdf only must be less than or equal to 2mb.) *

Upload Complaint Related Documents (pdf only must be less than or equal to 2mb.) *

If Nature of Complaint is negligence

Negligence

Was complaint lodged in any other forum/Department/Court?

Nature of the Complaint

Name of Forum *

Upload Petition/Application (pdf only must be less than or equal to 2mb.)

Was complaint decided by forum/Department/Court?

Complaint Fee

Amount 250 RS.

Demand Draft Number *

Date *

Name of Bank *

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