UNITED STATES DISTRICT COURT 

DISTRICT OF OREGON 

PORTLAND DIVISION 

JacQueline Pinch 

(Enter full name of plaintiff(s)) 

Plaintiff( s ), 

v. 

Dr. John Sorensen 

The Oregon Board of Dentistry 

ClearChoice Dental Implant Centers 

(Enter full name of ALL defendant(s)) 

Defendant( s ). 

I. PARTIES 

(to be assigned by Clerk of the Court) 

COMPLAINT 

Jury Trial Demanded 

0 Yes 0No 

List your name, address, and telephone number below, and the same information for each 

defendant. Make sure that the defendant(s) listed below are identical to those contained in the 

caption of the complaint. Attach additional sheets of paper if necessary. 

Plaintiff Name: _________ J_a_c_g~u_e_li_n_e_P_i_nc_h ____________ __ 

Street Address: P.O. Box 241 

City, State & Zip Code: Tualatin, OR 97062 

Telephone No. 503-699-1717 

COMPLAINT Page 1 

Revised: July 20, 2010 

Kl 

Case 3:14-cv-01995-KI Document 2 Filed 12/12/14 Page 1 of 5
Defendant No. 1 

Defendant No. 2 

Defendant No. 3 

Defendant No.4 

Name: --------~D~r~·~J~o~h~n~S~o~r~e~n~s~e~n __________ _ 

Street Address: 12750 SW 68th Avenue 

City, State & Zip Code: Portland, OR 97223 

Telephone No. 503-639-5599 

Name: --------~T~h~e~O~re~g~o~n~B~o~a~r~d~o~f~D~e~n~t~is~try~-

Street Address: ___ 1.:...:5:;..;:0;..;;0;.....;S;:;..W:...;_1.:...:s;,;;,t ..:...A;.;.v.;;.e;,l..., ....;;S~te;:..;,·....:..:#....:..;7...:..7...:....0 

City, State & Zip Code: __ P_o_rt_la_n_d.:...., O_R_9_7_2_0_1 __ _ 

Telephone No. 971-673-3200 

Name: ClearChojce Dental Implant Centers 

Street Address: 12750 SW 68th Avenue 

City, State & Zip Code: Portland, OR 97223 

Telephone No. 503-707-0111 

Name: -----------------------------

Street Address: -----------------

City, State & Zip Code: --------------

Telephone No. 

II. JURISDICTION 

Federal courts are courts oflimitedjurisdiction. Only two types of cases can be heard in 

federal court: cases involving a federal question and cases involving diversity of citizenship of the 

parties. A case involving the United States Constitution or federal laws or treaties is a federal 

question case. A case in which a citizen of one state sues a citizen of another state and the amount 

in damages claimed is more than $75,000 is a diversity of citizenship case. 

A. What is the basis for federal court jurisdiction (check all that apply) 

[XI Federal Question D Diversity of Citizenship 

COMPLAINT Page 2 

Revised: July 20, 2010 

Case 3:14-cv-01995-KI Document 2 Filed 12/12/14 Page 2 of 5
B. If the basis for jurisdiction is Federal Question, what federal Constitutional, statutory, or 

treaty right is at issue? 

n/a 

C. Ifthe basis for jurisdiction is Diversity of Citizenship, what is the state of citizenship of each 

party? 

Plaintiff(s) state of citizenship ___ ....;n..:.:./.=a ______________ _ 

Defendant(s) state(s) ofcitizenship _ ___:n..:.:./=a ______________ _ 

ill. STATEMENT OF CLAIMS 

Claim I 

State here as briefly as possible the (acts of your case. Describe how each defendant was 

involved, when the conduct occurred, and any injuries you have suffored as a result. It is not 

necessary to give any legal arguments or cite any cases or statutes. 

See #5, Statement of Claims, in "Notations Regarding my Complaint" 

COMPLAINT Page 3 

Revised: July 20, 2010 

Case 3:14-cv-01995-KI Document 2 Filed 12/12/14 Page 3 of 5
Claim II 

State here as briefly as possible the (acts of your case. Describe how each defondant was 

involved, when the conduct occurred, and any injuries you have suffored as a result. It is not 

necessary to give any legal arguments or cite any cases or statutes. 

See #5, Statement of Claims, in "Notations Regarding my Complaint" 

Claim III 

State here as briefly as possible the (acts of your case. Describe how each defendant 

was involved, when the conduct occurred, and any injuries you have suffered as a result. It is not 

necessary to give any legal arguments or cite any cases or statutes. 

See #5. Statement of Claims, in "Notations Regarding my Complaint" 

(If you have additional claims, describe tlzem 011 another piece of paper, using tlze same outline.) 

COMPLAINT Page 4 

Revised: July 20, 2010 

Case 3:14-cv-01995-KI Document 2 Filed 12/12/14 Page 4 of 5
IV. RELIEF 

State briefly exactly what you want the court to do for you and the amount, if any, of 

monetary compensation you are seeking. Make no legal arguments. Cite no cases or statutes. 

See Notation about: IV. Relief in "Notations Regarding My Complaint" 

I declare under penalty of perjury that the foregoing is true and correct. 

Signed this _IDh_ day of __ -=D"-"e...,c=ec.:..:.m..:..:b=e:..:...r __ __,, 20j£. 

(Signature of Plaintiff(s)) 

COMPLAINT Page 5 

Revised: July 20, 2010 

Case 3:14-cv-01995-KI Document 2 Filed 12/12/14 Page 5 of 5