File a formal complaint online Please fill out and submit the form below to file a formal complaint against a dentist or dental assistant practising in Prince Edward Island. Person filing the complaint Given name(s) Last name Address Phone Email Client/patient (if different from the complainant above) Your relationship to the client/patient Given name(s) Last name Date of birth Dental professional's information (dentist or dental assistant) Given name(s) Last name Place of work Complaint details Nature of the complaint Communication Unprofessional behaviour Privacy/confidentiality Other : When did the incident occur? Have you tried discussing this complaint with the involved health professional? Yes No What do you hope to accomplish by submitting this complaint? Complaint narrative Document Upload You may attach up to two supporting documents to your complaint. Only PDF, JPG or PNG files not exceeding 2MB in size are accepted. Document 1 Document 2 Legal statements By submitting this form you: Acknowledge that you are lodging a written formal complaint and understand that the College will investigate all written formal complaints. Give permission to the College to access your records, and to request and receive copies of all medical and related records related to the complaint Give permission to the College to discuss and/or release part or all of the submitted information and supporting documentation with any person(s) named in the complaint, or any person(s) deemed necessary in the investigation. Certify that the details and information provided are true, accurate and complete to the best of your knowledge. Are you a real person? (no robots please)