JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Need for Dentists in Wake County NC
The purpose of this survey is to determine the need for dentists in Wake County North Carolina. I am asking for your responses as concerned dentist in Wake county. You may contact me at
drdkmacleod@gmail.com
Douglas K. MacLeod, DMD
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Dental License #
(needed to eliminate duplicate responses)
Your answer
Office Zip Code
*
(if you have multiple offices list each with a comma after each entry)
Your answer
Yrs in Practice
*
Years since Dental school graduation
0-5
6-10
11-25
26-40
41 or more
Practice time
*
Your average weekly work times
4-5 days/Wk
3 days/Wk
1-2 days/Wk
Retired RDH checks
Retired from practice but involved in Dentistry
Fully Retired from practice
Other:
Practice structure
*
Solo no associate
Solo with associate
Group (2 or more DDS with ownership)
Practice owner with many locations in NC and many contract DDS
Dentist without own office
Other:
Are you the owner of the practice you work in?
*
Yes
No
Other:
Required
Practice Type
*
Select one
General Dentist
Endodontist
Periodontist
Prosthodontist
Orthodontist
Oral Surgeon
Pediatric Dentistry
Dental Public Health
Oral and Maxillofacial Pathology
Oral and Maxillofacial Radiology
Required
Yearly survey # of Dentist
*
Would you support a yearly survey of Dentist in Wake county to determine the need for more dentists?
Yes
No
Required
Support another dentist?
*
Can the practice you work in support another dentist?
Yes
No
Required
Support another RDH?
*
Can the practice you work in support another RDH?
Yes
No
Specialty not using RDH
Required
New patient wait to for Appointment?
*
How many business days does a new patient have to wait to make an appointment in the practice?
Your answer
Wait time for appt with an RDH
*
How many business days does a patient of record have to wait to make an appointment with an RDH in the practice?
Your answer
Wait time for appt with DDS
*
How many business days does a patient of record have to wait to make an appointment with a DDS in the practice?
Your answer
Welcome a new practice opening next door?
*
Would you welcome a new practice opening next door to the practice? Check only one if you are a specialist the new practitioner is in your specialty
Yes
No
Required
Refer patients to new practice?
*
Would you refer patients to new practice opening next door to the practice?Check only one if you are a specialist the new practitioner is in your specialty
Yes
No
Required
Comments welcomed
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report