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File a Complaint / Report a Concern

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Your Contact Information

We need your name and email to send you a reference number and follow up. Everything else on this step is optional.

Full name *

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Email address *

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Incident Details

If applicable, kindly provide the following:

Visit/Incident Date *

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Time (optional)

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Your Complaint

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Up to 5 files, 10MB each. Images, PDF, or Word documents.

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Describe what happened *

Desired Resolution (optional)

What outcome are you hoping for?

After you submit, we'll email you a reference number (e.g. REF-1234) you can use to follow up on or check the status of your complaint. Please keep it somewhere safe — if it's lost, you may need to re-file your complaint.

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Thank you

Your complaint has been received. Our team will review it and follow up using your preferred contact method.

Your reference number Save this to follow up on your complaint later.

Let's get started — are you a new or returning patient?

Which clinic location works best for you?

Tell us about yourself

Full name *

Date of birth *

Phone number *

Email address *

Home address (optional)

Include Insurance Information (optional)

This would speed ⚡ up your appointment check-in.

PRIMARY INSURANCE INFORMATION ▶

INSURANCE COMPANY NAME *

HOLDER NAME *

HOLDER DATE OF BIRTH *

POLICY NUMBER

CERTIFICATION NUMBER

INCLUDE SECONDARY INSURANCE ▶

INSURANCE COMPANY NAME *

HOLDER NAME *

HOLDER DATE OF BIRTH *

SECONDARY POLICY #

SECONDARY CERT #

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Insurance Documents (optional)

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What brings you in?

Briefly describe the reason for your appointment.

Reason for visit (optional)

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If you have any recent X-rays, tooth photos, or other relevant documents, you can upload them here.

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When would you like to come in?

We'll confirm your appointment by phone or email.

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Anything else we should know?

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You're all set!

Thanks for requesting an appointment with Greenwoods Dental. Our team will call or email you within one business day to confirm.

Questions? Call us at 1-866-774-0006

🦷 Greenwoods AI Assistant