Online Grievance Form

Your complete satisfaction with the dental plan is our primary concern. In order to efficiently and effectively provide you with the best service, please complete this online form regarding your issue. Once you have completed all applicable fields including required fields (indicated by an *), please review and click Send to submit the form.

Contact Information

Date of Incident: *
Name: *
Subscriber's SSN:
Address: *
City: *
State: *
Zip Code: *
Daytime Telephone:
Evening Telephone:
Dental Office:

Incident Details

The following explanation boxes are limited to 3200 characters each. If you need to provide additional information, please contact us using the information on the right.

Complete details of incident: *
What attempts have you made to resolve the problem/concern with your dentist?
Specific action you are requesting: *

Make sure you have completed all required fields. Please check the information for accuracy. By clicking Send, you are certifying the accuracy of your statements and requesting action from UDC Dental California. After you submit the form, you will receive a confirmation page to print for your records.

Additional Resources

Contact Information

UDC Dental California, Inc.

6310 Greenwich Drive, Suite 210

San Diego, California, 92122

Toll Free: 800.821.1294

Telephone: 858.812.8230

Facsimile: 858.678.0692

Adobe Acrobat Reader is required to read or print PDF files. Download it here.

If you would like a copy of UDC's disclosure information, guidelines, or criteria used to authorize, deny, or modify dental services, please contact us at 800.821.1294 ext. 8241.