SHARE YOUR STORY

Share Your Story
Is it hard to find a dentist that will take your insurance? Do you have to travel far or wait in long lines - only to be turned away? Does it cost too much even if you have insurance? Whatever your thoughts are, we want to hear from you! We are collecting stories to learn more about the challenges everyday families face when trying to find affordable, quality dental care in their communities. We have gathered together a coalition of more than 200 organizations and individuals who are working to improve Florida's oral health care system. If you give us permission to share your story, we may use it on our website, and in printed and online educational materials. For your privacy and protection, we will not publish your full name and will remove other identifying details from your story to protect your anonymity.
Your Name*

First NameLast Name
E-mail*
Phone Number (so we may contact you if we have questions, this is not for publication)

Area CodePhone Number
County in which you live
Zip Code*

Street Address

Street Address Line 2

CityState / Province

*This is just for demographic information. We will never share this data.
TELL US YOUR STORY
Write your story here (character limit: 65,000)*
May we share your story with others publicly?*

Yes, but identify me by first name and last initial only, along with countyNoYes, but identify me only as anonymous
If you answered "yes" to question above, here's how your story may be shared

If we select your story for publication, it could appear on the Floridians for Dental Access website (floridiansfordentalaccess.org) or that of our partner, American Children's Campaign (iamforkids.org). It may also appear on social media platforms, publicity, advertising, and in flyers, handouts and other printed and digital materials. You agree you will not be compensated for either sharing or the use of your story.

Unless you specified otherwise, you'll typically be identified with your first name and last initial only. We may also share the county in which you live.
Would you like to receive updates, action alerts, top stories about our progress in increasing dental access in Florida?

YesNo
What type of dental insurance do you have?*

NoneMedicaid (adult)Medicaid (child)Private dental insurance, e.g., Aetna, Metlife, Florida Blue Dental, etc.MedicareOther
Sometimes reporters doing stories about dental access in Florida like to speak to individuals about their experiences. Would you be willing to speak with a reporter if the occasion arose? We would share your phone number and email address with the reporter, and give you a heads up that they are trying to contact you.

Yes, I would like to speak with a reporter.Yes, I will speak to a reporter. But I only want to be identified by first name and county in their story. Please share that with the reporter.No
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Share Your Story