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Enrollment Questionnaire

For new members, please complete the Enrollment Questionnaire by clicking on the “Enrollment Questionnaire” link above.  Then, please watch for an email from our National Coordinating Center that will provide a secure link to continue.  To ensure that this email does not go to junk mail, please add this email to your acceptance list: CHR-NDPBRN-HUB@kpchr.org

If you are already a network member and need to update your questionnaire, please contact your Regional Node Coordinator (see https://www.nationaldentalpbrn.org/map-regions/ for contact information).  The information from your prior questionnaire will be pre-populated for your convenience.

Only dental professionals who practice in one of the United States or Territories are eligible for enrollment at the limited or full levels. Professionals outside of the United States may enroll at the informational level only.

The Enrollment Questionnaire is completed electronically ONLY and requires an email address. A printed version of the Enrollment Questionnaire is available for reference or reviewing the questions prior to enrollment.

printed version of the Enrollment Questionnaire that was used from 2005-2019 is available for historical reference.

If you have any questions, please contact Andrea Mathews, National Dental PBRN Program Manager, by email at nationaldpbrn@uab.edu.

For new members, please complete the Enrollment Questionnaire by clicking on the “Enrollment Questionnaire” link above.  Then, please watch for an email from our National Coordinating Center that will provide a secure link to continue.  To ensure that this email does not go to junk mail, please add this email to your acceptance list: CHR-NDPBRN-HUB@kpchr.org

If you are already a network member and need to update your questionnaire, please contact your Regional Node Coordinator (see https://www.nationaldentalpbrn.org/map-regions/ for contact information).  The information from your prior questionnaire will be pre-populated for your convenience.

Only dental professionals who practice in one of the United States or Territories are eligible for enrollment at the limited or full levels. Professionals outside of the United States may enroll at the informational level only.

The Enrollment Questionnaire is completed electronically ONLY and requires an email address. A printed version of the Enrollment Questionnaire is available for reference or reviewing the questions prior to enrollment.

printed version of the Enrollment Questionnaire that was used from 2005-2019 is available for historical reference.

If you have any questions, please contact Andrea Mathews, National Dental PBRN Program Manager, by email at nationaldpbrn@uab.edu.