Volunteer Form – Dentists

Volunteering offers you the opportunity to make a real difference in the lives of some of Australia’s most underprivileged people. Please sign up to be on our list of volunteers who stand ready to give their time and expertise to help those in need.

* Please note, you must have at least 2 years of clinical experience to participate in the program

    Personal Details
    First Name*
    Last Name*
    Email*
    Phone*
    Professional Details
    NOYES
    Please provide your Member Number
    If you like to know more about ADA NSW and benefits of being a member, please email [email protected] or call 02 8436 9900.
    Please provide your AHPRA Registration Number*
    Number of years practicing* (minimum 2 years experience to participate in the program)
    Please provide your Professional Indemnity Insurance Policy Number*
    Which University did you graduate from?*
    What year did you graduate?*
    What other languages do you speak other than English?
    What are you hoping to gain from volunteering?
    Have you volunteered for clinics at ADA NSW or with ADHF? Please provide details including the year you volunteered.
    Volunteer Yourself

    Filling the Gap runs charity clinics in the four chair facility of the Clinical Training Centre at ADA NSW in St Leonards. These clinics are run in partnership with charities that support patients who have difficulty accessing dental care. We see a variety of patients including asylum seekers and disadvantaged Australians in urgent need of care.

    Charity Clinics
    Are you interested in volunteering for Clinics with Sydney Charities?
    NOYES
    Are you interested in volunteering for Red Cross Clinics for asylum seekers?
    NOYES
    Do you prefer to bring your own Dental Assistant?
    NOYES
    When we run clinics, we provide catering, therefore do you have any dietary requirements?
    Which of the following services are you willing to undertake?
    FillingsScalingExtractionsLimited Pulpotomies
    Any additional information? (e.g. any days between Monday and Saturday when you are unavailable, etc)
    Volunteer your Dental Assistant

    Are there any days you are not in your clinic and your DA is under-utilised? We always need DAs for our clinics. If you have a DA who would like to join us – consider supporting them to attend.

    Can you support your DA to join us at a Filling the Gap Charity clinic?
    NOYES
    Volunteer Your Private Practice

    Filling the Gap, together with various charity organisations, through a coordinated volunteer program, enables dentists to volunteer within their own practice, providing pro bono dental treatment to those in need of dental intervention.

    Dental Rescue Days

    Dentists and their staff provide dental care to a group of patients over a half day or full day within their own practice. Patients are referred by local charities and not-for-profit organisations and may have acute dental conditions, be in pain or, because of their circumstances, have been unable to access timely dental care.

    Are you interested in volunteering yourself and your practice for Dental Rescue Days?
    NOYES
    How many Dental Rescue Days can your practice run a year?
    none1 - 23 - 55+
    Adopt a Patient

    Volunteer dentists and their staff are paired with one or more patients in need of more complex dental care and the practice will 'adopt' the patient over a few appointments to complete a course of pro bono treatment.

    Are you interested in volunteering yourself and your practice for Adopt a Patient?
    NOYES
    You are volunteering for Adopt a Patient as:
    Approximately how many Patients can you 'adopt' in a year?
    none1 - 23 - 55+
    Practice Details
    Practice name*
    Practice Location*
    Suburb*
    Post Code*
    State*
    Email*
    Phone*
    Notice and consent

    Filling the Gap is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide services you requested from us. From time to time, we would like to contact you about our services, as well as other content that may be of interest to you.

    Read our Privacy Policy.

    Posted on July 2nd, 2019
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