Rhode Island School Dental Screening Survey

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Dear Parent, This year the Oral Health Program at the Rhode Island Department of Health has suggested not performing the traditional school screenings because of school restrictions related to COVID-19. In place of the screening, we are asking your help with a survey. We ask that you take a moment to look at your child's teeth and indicate level of need. For those without a dentist, resources will be provided to help you find one. Please answer the questions below and click Next once completed. You will be taken to additional sections with questions and information. At the end, please click Submit.

Email *

Hope Valley Elementary School

Student first and last name *

Date of birth

YYYY

Grade *

Kindergarten

1st grade

2nd grade

3rd grade

4th grade

What are your child's dental needs? *

Just regular cleaning or other services to prevent dental problems in the next 6 months

Non-urgent- needs a filling, tooth removal or other treatment to be completed in the next few months

Urgent- needs care very soon due to pain or infection

Other:

Do you need help finding a dentist? *

Yes

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