Georgia Professional Licensure Complaint Form

Dentistry

Please use the following form to submit a complaint to the Georgia Board of Dentistry.

The Board investigates complaints of alleged violations of the Georgia Dental Practice Act and the Board’s rules.  Please be advised that the Board does not have the authority to settle fee disputes, nor does it settle personality conflicts. You may use the following form to submit a complaint to the Georgia Board of Dentistry if your complaint pertains to the practice of dentistry or dental hygiene. 

NOTE: All fields marked with asterisks (*) are mandatory.


Enter area code and phone number as 123-456-7890
Enter area code and phone number as 123-456-7890
NOTE: The Georgia Board of Dentistry ("Board") does not have authority over dental groups, practices, clinics or offices. Therefore you must provide the full name -- first and last -- of the individual dentist and/or hygienist who is the subject of the complaint.

Please provide the first and last name of the dentist/hygienist that is the subject of the complaint.

 

Complete Address (include street, city, state and zip)
Enter area code and phone number as 123-456-7890
Please provide a detailed explanation of your complaint, including full names, addresses, dates, etc. regarding all parties involved. Please keep a copy of this complaint information for your records. Once it is possessed by the Board, it is confidential under state law and cannot be provided back to you.