Get Complaint Form For Nj Div Of Dentistry 2020-2025

Filing a complaint with the New Jersey Division of Dentistry can be an important step in addressing concerns regarding dental practices. This guide will provide clear and supportive instructions on how to effectively fill out the Complaint Form online, ensuring you understand each section and the information required.

Follow the steps to successfully complete the complaint form online.

1. Press the ‘Get Form’ button to obtain the Complaint Form and open it in an appropriate editor.
2. Fill out the 'Consumer Information' section, including your name, address, and telephone numbers. Ensure all information is accurate and clearly written.
3. In the 'Complaint Reported Against' section, provide the name and business details of the individual or entity you are filing the complaint against. Include their address and any relevant contact information.
4. Describe your relationship to the consumer or patient involved by selecting the appropriate option from the list provided.
5. If the complaint involves another consumer or patient, fill out their information, including name, date of birth, address, and contact details.
6. List any other practitioners or licensees involved in the matter. Provide their details, including name, title, license number, and address.
7. Identify any witnesses to the complaint by filling in their names, addresses, and contact numbers.
8. Indicate the nature of your complaint by checking all applicable boxes and providing additional comments as necessary.
9. Describe the facts related to your complaint in chronological order, using clear language. If you need more space, feel free to attach additional sheets.
10. Document any previous actions you’ve taken to resolve this matter, stating these clearly.
11. Attach any relevant supporting documents, such as invoices, contracts, or correspondence, ensuring you do not send original documents.
12. Sign the form in the designated signature area and date it. Ensure the certification is completed by the person who filled out the form.
13. Once you have completed the form, save your changes, download a copy for your records, and prepare to print or share it as needed.

Complete your complaint form online today to take an important step in addressing your concerns.