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Share Your Story
We want to hear from you about how having dental and/or vision insurance has improved your health, confidence or well-being! Questions marked with an asterisk (*) are required.
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1.
What is your first name?
(Required.)
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2.
What is your last name?
(Required.)
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3.
What is your email address?
(Required.)
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4.
Which of the following best describes you?
(Required.)
I am a member who gets insurance through my employer.
I am a member who purchases insurance on my own.
I am a dentist.
I am an employer or group admin.
I am a broker.
I am a Delta Dental employee.
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5.
How long have you been with Delta Dental of Arizona?
(Required.)
Less than 1 year
1 - 5 years
6 - 10 years
11 - 15 years
16+ years
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6.
How has Delta Dental of Arizona helped you?
(Required.)
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7.
What do you love most about Delta Dental of Arizona?
(Required.)
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8.
Tell us about your experience with Delta Dental of Arizona!
(Required.)
9.
Electronic Consent
Yes - I consent to my information, excluding last name and email address, being used by Delta Dental of Arizona on marketing and promotional materials including but not limited to: website, social media, email, documents, press releases, etc. I agree that a Delta Dental of Arizona representative may contact me via email regarding the information I submit to clarify details, provide additional consent for use outside of the definition of advertising, or after one year of submission to confirm my information remains accurate.
No - I do not consent to my information being use by Delta Dental of Arizona on marketing and promotional materials.
