Submit a Concern

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Before you submit a concern, you should be aware that:
• The College of Dental Surgeons of Alberta (CDSA) only regulates the profession of dentists. If your concern or complaint is regarding a staff member who is not a dentist, please contact their appropriate College.
• All concerns are reviewed by the Professional Conduct Department (PCD).
• Concerns may be submitted anonymously.
• Concerns are often resolved through communication between the patient and dentist or with the assistance of the PCD.
• Some concerns may immediately transition into formal complaints if they include a risk to public safety.

A reminder that the College DOES NOT:
• Provide diagnosis, referrals, treatment recommendations.
• Provide refunds or award damages.
• Initiate an investigation without informing the dentist.
• Conduct investigations about dentists from outside Alberta.

Your Information
Not required if submitting anonymously

Name
First Last

Phone

Email
Enter Email Confirm Email

Address
Street Address Address Line 2 City Province Postal Code Country

Your relation to this concern

If you selected "other" please describe your relation to this concern

Patient Information

Patient date of birth
If you are the patient involved in the complaint, fill in your date of birth and proceed. If you are submitting on half on another person, fill in the birth day followed by the details of that individual. If the patient is remaining anonymous, you can skip this section.
Month
Day
Year

Patient Name
First Last

Patient Phone

Patient Email

Patient Address
Street Address Address Line 2 City Province Postal Code Country

Your Relationship to the Patient

Add Another Patient
Yes

Add Patient

Patient date of birth
Month
Day
Year

Patient Name
First Last

Patient Phone

Patient Email

Patient Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Relationship to the Patient

Dentist Information

Dentist Name
First Last

Dental Clinic Name

Dental Clinic Address
Street Address Address Line 2 City Province Postal Code Country

_{If you consulted with or received care from any other dentist in relation to this concern, it may be helpful for us to know that information. We may obtain records from the other dentist. If you list the names of additional dentists, this does not mean you are filing a complaint about them.}

Were other dentists involved in your care?

Yes

No

Add Dentist

Name
First Last

Dental Clinic Name

Dental Clinic Address
Street Address Address Line 2 City Province Postal Code Country

Describe Other Dentist's Relation to Concern

Add another dentist
Yes

Add Dentist

Name
First Last

Dental Clinic Name

Dental Clinic Address
Street Address Address Line 2 City Province Postal Code Country

Describe Healthcare Providers Relation to Concern

Information About Your Concern

Describe your concern in detail

Please upload any supporting evidence (receipts, records, correspondence) that is relevant to your concern

Drop files here or

Max. file size: 256 MB.

Supported files: .doc, .docx, .pdf, .jpg, .txt

Name
This field is for validation purposes and should be left unchanged.