Evaluation of Donated Dental Services (DDS)Now that you have completed dental treatment, we ask that you take a few minutes to evaluate the DDS program. Your input is important to us so we may improve the experience for others who go through the program.Name First Last State* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State The Referral ProcessHow did you hear about the DDS program?* Internet Search Medical Provider Social Worker Referral Friends/Family The coordinator treated me in a caring and professional manner.*Strongly disagreeDisagreeNeutralAgreeStrongly agreeThe coordinator was available to help me with my questions.*Strongly disagreeDisagreeNeutralAgreeStrongly agreeThe coordinator clearly explained the process.*Strongly disagreeDisagreeNeutralAgreeStrongly agreeMy coordinator was able and willing to help me.*Strongly disagreeDisagreeNeutralAgreeStrongly agreeAre you interested in sharing your story with Donated Dental Services (DDS) to help recruit more volunteers?* Yes No What is the best number to reach you at so you can share your story?*Dental TreatmentWere you treated courteously by the volunteer dentist and staff?* Yes No Why do you feel like you were not treated courteously?* Were you given instruction on proper care of your teeth and gums?* Yes No Were you comfortable with the treatment provided?* Yes No Were you given an explanation of treatment options?* Yes No Please comment on any "no" responses to the questions above.* What plans have you made for future dental care?*Have you recommended your dentist(s) to family, friends etc.?* Yes No If not, why?* Did you write a "thank you" note to the dentist(s) and their staff?* Yes No If not, why?* What are you able to do today (now that you've had this dental work) that you couldn't do before?*Please use this space for any additional comments you may have.
