Volunteer Care Reporting

Thank you for submitting information to our charitable care registry! This information will help the IDA keep lawmakers and other interested parties informed about the amount of free and low-cost dental care that Indiana dentists provide to the public. We greatly appreciate your contributions to the oral health of Hoosiers.

Member name(s)-List all participating dentists

Your email

Event name, if any

Share details of event, if any

City of event or place of care

Number of patients treated

Date(s) of treatment

Volunteer time in hours

Estimated value of donated treatment based on your usual and customary charges

Please indicate the number of completed procedures. For example, a full upper and full lower denture should be recorded as two full dentures.

Examination

Xrays

Prophy

Fluoride Treatment

Crown and Bridge Units

Full Denture(s)

Denture Reline(s)

Restorations

Space Maintainer

Orthodontic Treatment

Routine Extraction(s)

Surgical Procedure(s)

Describe Surgical Procedure(s)

Scaling and Root Planing-List # of quadrants

Endodontic Treatment

Implant(s)

Other

Describe Other

Volunteer Care Reporting

CLASSIFIED ADS

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