Dental Volunteer Opportunities Available Nationwide

Volunteer Today!

Thank you for choosing to see a patient in need in your office!

Please fill out this short form and your local DDS coordinator
will contact you soon with next steps.

Special thanks to Guardian Life Insurance® for its support!

First Name*
Last Name*
Email Address*
I am a:*
Office Address*
Enter your Zip and we'll do our best to fill out city and state.

Street Address City State ZIP Code
County*
Office Phone*
Lab Name*
Office Address*
Enter your Zip and we'll do our best to fill out city and state.

Street Address City State ZIP Code
County*
Laboratory Phone*
Specialty?*
Address*
Enter your Zip and we'll do our best to fill out city and state.

Street Address City State ZIP Code
County*
Phone Type:*
Phone:*
What prompted you to volunteer?*
Other reason for volunteering:*
What type of patient would you like to see first?*
- Select All
- Any DDS patient in need
- Veteran