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Last Updated: 09/29/11 02:45:08 PM

J-1/H1B Physician and Employer Complaint and Comment Form
NOTE: You are not required to complete the identifying fields. If you do, please note that this information is considered a public record and can be released upon request. However, if this information is not complete, it will be difficult to investigate your concerns.

Personal Information

First Name:

Last Name:

Email Address:

Phone:

J-1/HB1 Physician & Employer Information

J-1H1B Physician: Yes No

J-1H1B Employer: Yes No

Other:

Comments

Comments:

 

 
 

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Nevada State Health Division
4150 Technology Way
Carson City NV 89706-2009
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