Basic Form for E-mailing

In order to report a doctor, please reference this form.

Doctor's Name:

General Area Doctor is Located (Country, State/Province, City):

Detailed Account of the Incident that Caused You to Write in:

Personal Remarks:

Then, e-mail me at grannysmithsociety@proton.me with the body containing the filled out form above. I also welcome any criticism on how I can make the form and website more accessible. Thank you!