DENTISTS: APPLY BELOW

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1. What Does the D in MOD stand for?

*Intentional false answers may be reported to your state board

1. 1.) Have you been practicing dentistry for at least 4 years?

   2.) Do you provide clinical dental care at least 20 hours/week?

   Yes to Both No to Either

1. 3.) Are you an owner or partner in your practice? (Not an employee or associate dentist)

   4.) Do you use loupes or other magnification?

   Yes to Both No to Either

1. 5.) Do you average at least 30 minutes per week on continuing education? Please include time you spend reading dental magazines, on web-forums, any online C.E., study clubs, at dental meetings, and at courses, videos or webinars.

   Yes No

1. 6.) Do you do a periodontal screening, TMJ and occlusion check and a basic oral cancer screen as part of all your adult exams?

   7.) Do you use a headlight, fiberoptics or other auxiliary lighting for all procedures?

   Yes to Both No to Either

1. 8.) Have other health care providers (or their families) chosen you for treatment? Please include doctors, dentists, therapists, pharmacists, nurses (RN or LPN), optometrists, medical technicians, EMT's etc.

   9.) Do you have at least 10 patient reviews that are less than three years old?

   Yes to Both No to Either

1. 10.) Are you confident that your average online reputation score is 3.9 (out of 5) stars or higher, based on patient reviews?

   11.) If asked, could you provide 3 or more excellent testimonials from colleagues that rate you at least 4 (out of 5) stars?

   Yes to Both No to Either

1. 12.) Do you belong to any of the following: ADA, AGD, AACD, DOCS, a local study club, or any other dental organizations or associations? Explanation: You may also include memberships in dental web-forums, such as Dentaltown, Crown Council etc.

   Yes No

1. 13.) Do you feel you are a better dentist than at least 75% of your colleagues?

   14.) Please answer "Yes" if you do NOT have any health issues that might compromise your ability to provide optimal care to your patients.

   Yes to Both No to Either

1. 15.) Have you updated your office facility & décor within the last 7 years?

   16.) Do you use at least two (2) of the following technologies: Intraoral camera, Digital x-rays, Laser, Radiometer (for curing light), Apex locator, Chairside sandblaster, Digital impressions, Digital panoramic, or Cad-Cam?

   Yes to Both No to Either

1. 17.) Please answer "yes" if in the last 4 years:
   a. Your dental and drug prescribing licenses have been current and NOT been modified.
   b. You have not had to appear before a state dental board, lost any malpractice claims, or been convicted of a felony.

   Yes to Both No to Either