REQUEST FOR MEDIATION


The Patient Relations/Peer Review Committee was established to mediate disputes that may arise between a patient and a member dentist of the Northern Virginia Dental Society (NVDS), a component society of the Virginia Dental Association (VDA), to review matters concerning, but not limited to, appropriateness of care, quality of care, and sometimes, when acting in an advisory capacity, fees. If a problem arises, be sure to talk with your dentist in an effort to resolve the problem as sometimes, it is simply a miscommunication. If speaking to the dentist does not resolve the issue, you may file a complaint and request for mediation.

The following steps must be taken for a patient to begin the mediation process:

  1. Patient must check to ensure the dentist is a member of the NVDS/VDA. Click HERE to search our membership list. If the dentist is NOT a member of NVDS/VDA, please file your complaint on-line directly with the Virginia Board of Dentistry.
  2. It is important to note that NVDS cannot accept complaints solely based on seeking financial refund of fees to the patient or to another dentist. Please use the space provided on the mediation form to state the details of the problem specific to treatment. Please be concise in your description. Copies of bills/receipts may be attached to the form.
  3. Mediation requests must be in writing, and then postal mailed to the address located on the form. NO mediation takes place at this address.
  4. Once the form is received, a mediator will contact you as soon as conveniently possible.
  5. The patient relations/peer review process was not designed to handle every type of situation and cannot consider cases in litigation or when legal intervention on the part of either party is initiated, dentist to dentist complaints, alleged fraud, and other violations of State Dental Practice Acts.

NVDS Request for Mediation Form