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 click Preview Submitted Form to review the form.

Contact Information
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.

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.