Help UAPD Save Dental Jobs Exit this survey The information you provide here will save doctor jobs. You can provide your name at the end of the survey or submit the information anonymously. Question Title * 1. Tell us About Yourself Name: Workplace: Non-Work Email Address: Phone Number: Question Title * 2. In which county do you work? Question Title * 3. In which facility do you work? Question Title * 4. Do you know of any BU 16 dentists who have retired in your facility in 2012, or plan to retire soon? Sharing this information with UAPD will NOT jeopardize the retirement plans of these workers. Yes No Question Title * 5. Please list the names of all recent and imminent dentist retirees that you know of: Question Title * 6. Do you have Limited Term Dentists working in your facility? Yes No I'm not sure Question Title * 7. Please list the names of all Limited Term Dentists you know of: Question Title * 8. Do you have Contract Dentists working in your facility? Yes No I'm not sure Question Title * 9. Please list the names of all Contract Dentists you know of: Question Title * 10. Can you provide UAPD with concrete evidence that demonstrates that the dentist-to-patient ratio being implemented has harmed or will harm patients and/or cost the state money? Yes No I'm not sure Please specify: Question Title * 11. Would you be willing to engage in a legal direct action at your workplace, such as an informational picket, in order to protect dentist positions? Yes No Maybe Ideas for actions: Question Title * 12. Any other questions or comments? Done