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Charitable Care Reporting Form Submission

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Charitable Care Reporting Form

You can help VDAF and the dental profession by recording the charitable dental care that you provide on this form. To record multiple events, complete the form for Event 1, click "Submit" and complete the form again.

Your Information

Name(*)

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Dental office/dentist(*)

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Address(*)

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City(*)

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State(*)

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Zip(*)

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Email(*)

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Telephone

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Date of Care(*)

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Zip Code of Treatment(*)

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Was the care part of an event?(*)

YesNo

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Number of Patients Seen

Adults(*)

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Children(*)

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Total Hours(*)

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Dollar Amount of Care Provided

Preventive

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Restorative

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Emergency

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Other

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Other Description

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Comments

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Antispam(*)

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Typograpy and Internal Formats

The Virginia Dental Association Foundation would like to thank the following organizations for their support of the Donated Dental Services program.

What is the need?

Donated Dental Services (DDS) is a program that provides comprehensive dental care to eligible seniors and adults with disabilities.

"Thank you for making me smile. Thanks so much for your care, concern, timing calls, a job well done."
-DDS Patient, Richmond, VA

"I really enjoy giving back to those less fortunate in our community by providing them with complimentary dental services. It is extremely rewarding to donate our skills to these appreciative patients and witness the dramatic improvement in their health and self-esteem."
-Dr. David L. Jones, Gardner & Jones Orthodontics

Click Here To Volunteer With Donated Dental Services
Apply For Donated Dental Services (as a patient)

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VDAF Success Stories

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“P.G. grew up in New Jersey, the son of immigrant parents, and in 1944, barely of age, he enlisted in the army, specifically the paratroopers. P.G. was on only his second combat jump when he was captured by German troops and placed briefly in a concentration camp. By the grace of God, this was April,1945, and in approximately one month this camp was liberated by the allies, and P.G. survived.

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T. L.

Thank you so much for helping me with my teeth. The people there were real good to me and my son. The dentist and his staff treated me with great respect. I know these people will be blessed in what they do. I feel really good about my teeth now and that means a lot to me and my son! Thank you for being there. Bless you for your work.

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C. C.

Culpeper, Virginia

C.C., a veteran, needed dentures to help with glycemic control for management of his diabetes. Once our DDS volunteer dentist had completed full upper and lower dentures for C.C., he could not only eat a healthier diet but was thrilled that his beloved grandchildren were no longer frightened of his appearance and now happy to be near him!

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Joan-Johnson-with-Dr.-Swanson November-2014

J.J.

Fredericksburg, Virginia

J.J. needed assistance with getting the dental services she needed to improve her oral and overall health. In July of 2014 she turned to DDS for help. We were able to match her with a volunteer dentist to complete a treatment plan and a few days before Thanksgiving, J.J.’s dentures were delivered! Truly a wonderful gift for J.J. and the volunteer dentist!

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George D.McDiffett

Colonal Heights, Virginia

Dear Ms. Rollins :

I am pleased to write to say that the services you and the gracious dentists associated with your organization have provided my brother, Doug, are no less than a true miracle in the outlook, appearance and renewed pride my brother feels.

Once the year of waiting went by after his initial application for help in getting comprehensive dental work done, you contacted him and, from there, it was swift, professional, and extremely kind and non-judgmental care that he received from Dr. Poonum Bharal and the entire staff at Baxter Perkinson's dental practice. The offer of free care insinuated to me that it may be inferior care. Not so. This charitable work is QUALITY care of the highest standard - equal to that given to a cash paying patient. It was a mere two weeks from his initial consultation that his extractions of twenty one rotting teeth, fitting for dentures and, finally, placement of them.

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S. C.

You all have done a great job down at the Donated Dental Services. All the dentist that did work on my mouth did a great job. By looking at my before and after picture you saw how bad my teeth were! I am grateful for all you and the dentists have done for me. Thank you for making my life better.

Thank you

We just finished this nice gentleman's case. I will adopt him as a regular patient into our dental home. His change has been stunning. He seems much more confident and happier with his new smile, and seems very appreciative.

- Dr. S. G.

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M.B.

When I was 6 months old I had polio. All the medicine messed my teeth up so badly that they decayed. I used to hide my mouth when I talked. I taught myself to not open my mouth too wide because of my bad teeth. I saw Donated Dental on Facebook and I called. I talked to a wonderful person there. She felt my pain. I'm a pretty woman until I open my mouth. She helped me get my mouth together. My doctor, Dr. Lopez, was wonderful and her assistant Joan was wonderful too. She was so gentle with me. She made me very comfortable. When my daughters saw me with my new smile they cried. I want to thank the Virginia Dental Association Foundation, the Donated Dental Services program and Dr. Lopez very much!

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