Non-Federally Qualified Health Center Dental Clinics and Programs

The American Association for Community Dental Programs and Safety Net Solutions, a program of DentaQuest Institute, appreciates your assistance in completing the survey, which we believe will have lasting implications for the sustainability of dental clinics and programs.

This survey is best completed by the staff member with dental program decision-making authority and/or the staff member who is most knowledgeable about the dental clinic/program and how it fits into the larger organization.

Question Title

* Contact Information

Name of person(s) completing survey and degrees, if any:

Title:

Organization:

Address:

City/Town:

State:

Zip:

Question Title

* Organization and Clinic/Program Information

Name of organization executive director and degrees, if any:

Name of dental clinic/program director and degrees, if any:

How long has dental clinic/program director been in his or her position?