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 membership@adansw.com.au 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

ADA NSW Centre for Professional Development have a four chair facility that is used for short course training purposes. When this is available we run dental clinics as part of our partnership with the Red Cross to treat asylum seekers who have very limited access to dental treatment. We also run dental clinics with a number of Sydney based charities for patients that are having difficulty accessing dental 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 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 patient 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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