Dental Story Bank for Pennsylvania
PA Coalition for Oral Health (PCOH) is collecting stories from all 67 counties around dental issues in our state. We know that many people struggle to find dental care as a basic healthcare need, and we would like to help lend a voice to the changes needed in our system. Only 1 in 4 general dentists in PA accept Medicaid, and many of these are not accepting new patients, or their location requires people to travel for hours to get care. Your story can help us let decision-makers know that change is needed to protect the smiles of all Pennsylvanians. We will share these stories with the Governor's office, legislators, and the Departments of Health and Human Services to push for changes to the current system.

Most questions are optional, but please try to fill out the form as completely as possible. No names will be shared, but we do ask for your name and contact info in case we have follow-up questions.

Complete the survey by March 31st for a chance to win a $50 Amazon gift card!
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Your first name (will not be shared)
Your email (will only be used if we have a question about your story, never shared as part of the story itself)
Your phone (will only be used if we have a question about your story, never shared as part of the story itself)
Who is the person that you are sharing a story for?
How would the person describe themselves? (Age, race, ethnicity, gender, sex, disability status, etc. Only share information to the level of which you are comfortable)
County person lives in *
Does the person have dental insurance?
Clear selection
Please give a description of the dental problem (when it happened, trouble getting care, pain issues, trips to the Emergency Room, any solutions you came up with to solve the problem, or if it still exists) *
Would the person be interested in sharing a picture of the dental problem or sharing a brief video talking about the problem?
Clear selection
Clear form
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