Report a Covid-19 Related Concern
This form is a tool for the public to report a concern related to the practice of dentistry and the Covid-19 pandemic to the American Association of Dental Boards. Please complete the fields below to initiate your report. Please be specific as possible to help investigators. The information you provide will be shared with the relevant body that has regulatory jurisdiction concerning the alleged incident. Please note that we will accept anonymous reports. However, we encourage allegations submitted by known parties so investigators may follow up with questions.
Name of person filing the report:
Address of person filing the report:
Email of the person filing the report:
Phone number of the person filing the report:
Occupation of the person originating report:
Please provide the full name of individual(s) and license numbers if appropriate involved in the incident: *
Address of Incident: *
Date of Incident: *
Description of concern (please provide as much detail as possible): *
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