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NCCAOM REQUEST FORM

A request may be submitted regarding a situation or decision made by the staff at NCCAOM. Please complete the information below. NCCAOM will try to honor your request within the auspices of our compliance policies. The staff will respond within 2 business days to confirm receipt of the request and begin a review of the information provided.

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  • Please describe the basis of your request. The candidate/Diplomate should be specific when outlining the request or complaint and submit documentation with 30 days of the decision or event. An acceptable request for an event includes a situation that affects life circumstances (e.g., personal, family, medical, natural disaster). Documentation is required (e.g., reports, statements) and should be submitted within 30 days of the event.