Volunteer Sign-Up Form
"start where you are, use what you have, do what you can"
Dentists for the Disabled and Elderly in Need of Treatment, Inc.
Your Full Name
Your answer
Email
Your answer
Dental Office Address
Your answer
Dental Office Phone Number (including area code)
Your answer
Dental Office Fax Number (including area code)
Your answer
Dental Office Contact Name
Your answer
Website
Your answer
I am a
Oklahoma Board of Dentistry License Number
Your answer
Please select population you feel most passionate about helping through D-DENT:
Required
I would love to help restore the oral health of:
Required
What type of dental work will you provide through D-DENT?
My office is wheelchair accesible
Thank you for allowing us to help you make a difference, one smile at a time.
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