Dental Complaint Form
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3Massachusetts Department of Public Health
Bureau of Health Professions Licensure
The Bureau of Health Professions Licensure (HPL) investigates complaints and concerns regarding licensed
professionals (licensees) on behalf of the Boards of Registration (Boards) that license registered Nurses,
Licensed Practical Nurses, Certified Registered Nurse Anesthetists, Certified Nurse Midwives, Certified Nurse
Practitioners, Psychiatric Clinical Nurse Specialists, Clinical Nurse Specialists, Dentists, Dental Hygienists, and
Dental Assistants, Pharmacists, Pharmacy Interns and Technicians and Pharmacies, Nursing Home
Administrators, Physician Assistants, Respiratory Therapists, Perfusionists and Genetic Counselors.
When information from a complaint investigation indicates that a licensee has violated a law or regulation
relating to the particular profession, the licensing board may take administrative action against the licensee,
ranging from issuing an advisory letter, requiring a licensee to take remedial education, or discipline of the
individual’s license to practice, e.g., stayed probation, reprimand, remedial education, probation, censure,
suspension, and revocation. Each Board has its own regulations and practices related to discipline.
The HPL and the Boards of Registration cannot represent you in civil matters in a court of law or other tribunal
to recover fees paid or to seek remedies for injuries. You may wish to consult a private attorney regarding
these matters.
ISSUES THAT ARE NOT WITHIN THE AUTHORITY OF
THE HPL OR THE BOARDS OF REGISTRATION
Fee disputes, such as payment for broken or missed appointments
Billing disputes, such as the amount a licensee charges for services
Personality conflicts
COMPLAINT FORM INSTRUCTIONS
To file a complaint, you must submit a legible, signed and dated complaint that identifies the person or
entity who is the subject of your complaint.
If your complaint is about treatment you received, treatment or medical records are required to process
your complaint. The signature of the patient or legal guardian to the Authorization for Release of
Records and Referral of Complaint section is necessary.
Use a separate form for each person or entity against whom you wish to file a complaint.
Be specific in your complaint description, and include copies of pertinent medical records,
correspondence, contracts and any other documents that support your complaint.
HPL will send written notification of any action on your complaint.
If the allegations contained in your complaint are determined to be possible violations of applicable laws
and/or regulations, a complaint will be opened for investigation.
If your complaint is opened and assigned for investigation, a copy of the complaint will be provided to
the health care licensee or entity.
HPL may, in its discretion, investigate an anonymous complaint if the complaint is in writing; if the
complaint allegations constitute violations of law or regulations warranting Board action; if preliminary
inquiry reveals sufficient information to determine that the allegations may be true; and if proving the
allegations does not require the identification and/or testimony of the person filing the complaint.
____________________________________________________________________________
Bureau of Health Professions Licensure
239 Causeway Street, 5th floor, Boston, MA. 02114
PH: (617)973-0865
FAX: (617)973-0985
TTY: (617) 973-0988
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