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* 1. Are you interested in participating in a Group Health Plan organized by the Maine Dental Association for you and/or your employees?

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* 2. Are you:

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* 3. About how many employees work at your practice(s)? What percentage are full time?

If not actively practicing, please respond N/A.

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* 4. How many "lives" in your practice (this includes spouses and children up to the age of 26)? (estimates are fine)

If not actively practicing, please indicate how many people would you potentially sign up for the plan?

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* 5. How many employees currently have health insurance through your practice?

If not actively practicing, do you currently have health insurance?

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* 6. How many employees currently have health insurance through another source (other than the practice)?

If not actively practicing, please respond N/A.

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* 7. What are the general demographics of your practice's employees; are they mostly...?

If not actively practicing, what are the general demographics of the people you would be looking to sign up?

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* 8. What available choices are important to you?

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* 9. If you feel comfortable in sharing, knowing these answers will be held in confidence, what is a range of what your health insurance premiums cost now?

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