Questionnaire
How can you help? Let us know in this questionnaire. Thank you.

Type of work you would like to do (check all that apply):
	Endo Cases	Pedo Cases
	Oral Surgery	Perio
	Prothetics	Fillings
	SSC/Post Build-up	Impacted Thirds or Wisdom Teeth
	Composite Bridges on Anterior Teeth	Complicated/Difficult Cases
	Pediatric Sedation	Adult/Moderate Sedation
	In-Service Training
	Other:
Working Conditions (check all that apply):
	Only One Chair	Work Simultaniously with other Dentist
	Bring Own Dental Assistant	Adults
	Teens	Elderly Patients
	People with Disabilties	Spanish Speaking
	Paired with Dr.
Availability (check all that apply):
	Monday A.M. P.M. Wednesday A.M. P.M.   Evenings	Tuesday A.M. P.M. Thursday A.M. P.M. Friday A.M. P.M.
	Mid-Day (10-3) Shift	Long Day (8-3) Shift
	One Quadrant per Shift	Summer Only
	Have some questions? We will contact you. Your Name
	Please provide us the means to contact you (One or both): Your Phone   Your Email