You are receiving this survey because you previously signed up for the Dental OPTIONS program--the ODA's partnership with the Ohio Department of Health to provide free and discounted dental care to Ohioans who are low-income and do not have dental insurance but do not qualify for Medicaid.  Please respond to the survey to provide your willingness to see one or more OPTIONS patients in 2018 and other needed details.  All details provided through this survey will be provided to the Ohio Department of Health oral health staff for their use in coordinating patient care. 

* 1. Dentist's Name:

* 2. Are you willing to treat an OPTIONS patient in 2018?