Complaint Form - CDBC | The College of Denturists of British Columbia

Registrant Login

Complaint Form

Please Report your Complaint

COMPLAINT REPORT

First Name

Last Name

Complainant Address

Address Line 1

Address Line 2

City

Country

Province/State

Province/State

Postal/Zip

Phone

Email

Best Time to Call

Regulated Member

Denturist whom you are submitting a complaint against

Member Name

Member Address

Address Line 1

Address Line 2

City

Country

Province/State

Province/State

Postal/Zip

Member Phone

Would you be willing to appear before the Inquiry Committee and/or Discipline Committee if requested?

Enquiry

Yes

No

Date of Initial Examination

Date of Services Received

Type of Denture

Specific Service Received

Amount Paid

Any additional information you think might be useful for the Inquiry committee to consider. Please be as specific as possible.

Complaint

Complainant Signature

Complaint Date