The mission of the Kansas State Board of Examiners in Optometry is to administer and enforce the provisions of the Kansas Optometry Law so that the highest quality of eye care is provided to the citizens of Kansas. In our efforts to fulfill this mission it is important to hear from the citizens of Kansas. The link below is a form in Microsoft Word format meant to make the process of providing feedback to the Board easier for the consumer.

Complaint Form (Microsoft Word)

Complaint form (Fillable PDF)
Save to form to computer before completing it.  (See instructions below)

If you would like to tell us about a situation you have encountered with a Kansas licensed optometrist, please complete this form and send to:

KS Board of Examiners in Optometry
3109 W 6th St, Suite B
Lawrence, KS 66049
Fax:  785-856-2323

Instructions for Opening/Saving Fillable PDFs

Save the form to your computer before attempting to complete it

We suggest that you first download the PDF form to your computer or network drive, and then open it with Adobe Reader and fill it. You can either type information directly into each field, or copy and paste text. The font is preselected and cannot be changed. You can only type regular text (upper and lower cases); the system will not accept underlined text, bold or italics, script or formulas, curved or slanted apostrophes, double quotation marks or long dashes.

You can save your data and re-open the file later to modify or enter additional information.

To save the form: 

Fillable PDF forms may be completed and saved using Adobe Acrobat Reader (this software must be loaded on your computer). To accomplish this you must first save the empty form on your own computer:

  1. Position your cursor on the form link and click with your right mouse button (do not activate the link and open the form)
  2. From the menu that pops up, select the Save target as... option in Internet Explorer or the Save link as... or similar option in another browser
  3. You should then be prompted to choose a location to save the file
  4. Select the location on your own computer or network and click on the Save button
  5. Once saved, navigate to the file