Smile Spokane Provider Fluoride Toolkit
We have developed a toolkit to help medical and dental providers in the Spokane region have conversations with patients about the benefits of fluoride.

The toolkit contains a poster to put up in your office, a conversation guide, as well as rack cards and stickers to hand out to patients. You can request hard copies mailed to you free of charge. Just fill out the form below.

You can also download PDFs of the toolkit here: http://www.betterhealthtogether.org/smile-spokane-for-partners.

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How many toolkits would you like? *
How did you hear about this toolkit?
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We would like your input about which toolkit pieces would be most helpful to you. (Check all that apply.)
Are there any other materials you would find helpful in communicating about fluoride that we should consider including in the toolkit (e.g., a postcard to hand out to patients)?
Any special instructions or information you'd like to share with us?
Question for medical providers: Are you interested in integrating preventive oral health services into your practice? Smile Spokane and Arcora Foundation provide trainings, as well technical assistance and support. Providers who receive the training are eligible to bill Medicaid for the services (up to $70.00).
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