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REQUEST FOR MEDIATION


The Northern Virginia Dental Society’s (NVDS) Patient Relations Committee has been established to mediate disputes that may arise between a patient and a member of the Northern Virginia Dental Society.

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

  1. The patient needs to fill out a mediation form (see link below). The patient can check that the dentist is a member of NVDS by calling the Central Office at 703-642-5297. It is important to note that NVDS cannot accept complaints solely based on seeking financial refunds 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 the treatment. Please be concise in your description. Copies of bills and receipts may also be attached with the form.
  2. The form should be mailed to NVDS at: Northern Virginia Dental Society 4330 Evergreen Lane, Suite N Annandale, VA 22003
  3. Once the form is completed and received, we will be happy to assist you in the mediation process. A mediator from the committee will be in touch with you over the phone. No mediation is done at the Society’s Central Office so it is not necessary for you to travel to Annandale.

This form can also be used to state a problem that does not require mediation but which you would like to make a matter of record. If you have further questions, please do not hesitate to contact the Northern Virginia Dental Society at 703-642-5297.

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