Fake Medical Website Report Form
Report a suspicious or fake medical website. Please provide as much detail as possible to help us investigate your report.
Your Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Website URL
*
How did you find this website?
Please Select
Search engine
Social media
Referral from another site
Advertisement
Other
Reason you believe this website is fake
*
Category of Issue
*
Please Select
Phishing or scam
False medical claims
Impersonating a real provider
Malware or suspicious downloads
Other
Date you visited the website
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Upload any supporting evidence (e.g., screenshots)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Has this website caused any harm or loss?
Yes
No
Not sure
Additional Comments (optional)
Submit Report
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