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180049SMILE PATIENT GRIEVANCE FORM Date: Office Dentist/ Provider LocationPatient Name: Address: City, State Phone: PLEASE ENTER BELOW ANY COMMENTS OR OBSERVATIONS, POSITIVE OR NEGATIVE THAT YOU WISH

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What is 1-800-49-smile?

1-800-49-smile is a helpline for dental services.

Who is required to file 1-800-49-smile?

Dental service providers are required to file 1-800-49-smile.

How to fill out 1-800-49-smile?

1-800-49-smile can be filled out online or by calling the helpline.

What is the purpose of 1-800-49-smile?

The purpose of 1-800-49-smile is to provide dental care services information.

What information must be reported on 1-800-49-smile?

Information such as services provided, fees charged, and patient outcomes must be reported on 1-800-49-smile.

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