Patient Request For Mediation

Utilization of the Patient Relations & Peer Review Committee is a process to try to resolve a disagreement about dental treatment that a patient and a dentist have not been able to resolve themselves. 

The peer review process begins at the local level (component) where a complaint is reviewed by a peer review committee.  This committee is established to review matters concerning, but not limited to, appropriateness of care, quality of care, and sometimes, when acting in an advisory capacity, fees.

The peer review process was not designed to handle every type of situation and cannot consider cases in litigation, dentist to dentist complaints and alleged fraud and other violations of State Dental Practice Acts.

When a problem arises patients should first talk to their dentist in an effort to resolve the problem. If speaking to the dentist does not resolve the issue a complaint may be filed through the Virginia Dental Association and it will be referred to the correct local peer review committee.

All request/complaints must be made in writing. 

Download the pdf form to be mailed or faxed to us.

Submit your request ONLINE.