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* Occupation:	(Select One...) CDA RDA Dental Assistant DAI DAII Faculty Other
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* Country:	(Select a Country) United States Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic Cook Islands Costa Rica Côte d\'Ivoire (Ivory Coast) Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (north) Korea (south) Kuwait Kyrgyzstan Lao People\'s Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Zaire Zambia Zimbabwe Please select a country from the drop down list!
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Type of Dental Practice: (check all that apply) We do not share your specific user information with any third party. We use this information to help tailor our content to our readers interest.	Private Group Full-Time Part-Time Faculty General Practice Specialty - Restorative Specialty - Periodontics Specialty - Endodontics Specialty - Implants Specialty - Orthodontics Specialty - Pediatric Specialty - Prosthodontics Specialty - Oral & Maxillofacial Surgery Specialty - Oral Pathology Academia Dental Hygienist Dental Assistant Other
Did you attend a program in dental assisting?	Yes No
If so, what year did you graduate?	1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Invalid Year format! Example: 2007
Did you go through the DANB certification?	Yes No
Gender:	(Select One...) Male Female
Please indicate the number of dentists in your primary private practice:	(Select One...) Four or more Three Two One
How many patients does your practice treat per week?	(Select One...) 31 or more 21 to 30 11 to 20 1 to 10
How many hours per week do you provide direct patient care?	(Select One...) 40 to 49 30 to 39 20 to 29 Less than 20
How many dental assistants are in your primary practice?	(Select One...) 3 + 2 1 0
How many hours per week are you online for your profession?	(Select One...) Less than 5 6 to 10 11 to 20 20 +
How long have you been employed in your current position?	Select 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10+ years
Do you purchase the dental supplies for your office?	Select Yes No
If you purchase the supplies for your office do you also choose the products being purchased?	Select Yes No N/A
How many hours do you work per week?	Select 0 - 8 hours 9 - 16 hours 17 - 24 hours 25 - 32 hours 33 - 40 hours 40+ hours
Do you assist with mixing and prepping materials?	Select Yes No
Do you perform sterilization/disinfection functions?	Select Yes No
Does your office give out samples ?	Select Yes No
Would your office be interested in receiving patient education posters for your office?	Select Yes No
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