DEMOGRAPHIC INFORMATION

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* 1. What is the five-digit zip code of the main administrative site of your Health Center (HC)?

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* 2. If your HC has sites in any other state(s), please list the state(s) here:

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* 3. Which best describes the communities served by your HC? Please check all that apply.

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* 4. Which best describes your position?

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* 5. Are you a dentist?

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* 6. Does your HC have any sites where medical and dental services are co-located?

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* 7. Does your HC provide direct, on-site oral health care services to children (0-5) years?

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