Pitt Dental Boards Screenings Signup
The University of Pittsburgh School of Dental Medicine will offer select free dental care to qualifying patients who are available on Thursday, February 6, 2020 or Friday, February 7, 2020 after participating in a free cavity screening.

The Class of 2020 at the University of Pittsburgh School of Dental Medicine is preparing to take their clinical boards to obtain licensure. Patients are currently screened for specific types of cavities that fulfill requirements on the examination.

**ONLY patients who are screened and invited to serve as patients for board examination will receive free fillings and/or cleanings by a dental student on February 6th and 7th!**

Adult patients (age 18 and older) who sign up below will receive the following free services at screening:
• Cavity screening and x-rays
• Report identifying existing cavities
• Duplication and distribution of x-rays to your private dentist, if needed
• Fee waiver for initial exam if you receive treatment at the School of Dental Medicine
• Free oral health kit

Free screening sessions will occur in Salk Hall, on the following Wednesdays between 1pm to 4pm. The cavity screening process will take about 1 hour:

November 13, 2019
November 20, 2019
December 4, 2019
January 15, 2020
January 22, 2020
 
There is limited availability for each session, so please only register if you are committed. Please try to arrive at the School of Dental Medicine (Salk Hall, 3501 Terrace St., Pittsburgh, PA 15213) approximately five minutes early so you can be signed in. We will try our hardest to see you in a timely manner, and we appreciate your patience and cooperation.

If these dates do not work for your schedule OR if the dates are filled AND you are still interested in receiving free limited screenings, please email us at cdcascreenings@pitt.edu with your name, contact information, and preferred screening date. If an appointment opens or additional days are available, a dental student will be in contact with you.

Please note that submitting this form does NOT guarantee an appointment for a free dental screening.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Email Address *
Phone Number *
Screening Date (1 hour sessions) --only ONE per person. You will be contacted with your appointment start time (between 1-4pm). *
I confirm that I will be available to serve as a patient on either Thursday, Feburary 6 or Friday, February 7 at 7:30am-5pm if I qualify after screening. *
Any additional information that will help us schedule you (ie. time preferences).
Salk Hall (Next to Peterson event center)
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Cornell. Report Abuse
Google Forms