Patient Complaint Form Logo
  • Patient Complaint Form

    Instructions: Please fill out this form in its entirety and submit to be processed. A member of our team will get in touch with you. Thank you!
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  • By signing this complaint form, I request that the headquarters of Clear Lakes Dental resolve my complaint. I will provide any and all information and cooperate in helping the headquarters of Clear Lakes Dental resolve my complaint. To the best of my knowledge, this information is true and accurate.

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