Patient Complaint Form

The New York State Dental Association is a private, voluntary, professional association for licensed dentists in New York State. Membership with the NYSDA is not a NYS dental license requirement.

Please complete the form below if you have a complaint regarding the dental work that was performed and/or how you were treated by a dentist.

IMPORTANT NOTE: The NYSDA does not take complaints regarding billing or how you were treated by the office staff. Please contact the dental practice owner directly to discuss your concerns.

Dentist's Information

Your Contact Information

We will contact you with the appropriate next steps as soon as possible.