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Enrollment Questionnaire

As you may be aware, the Network has been funded to continue from 2019-2026 and we need updated information from our current members. An email will be sent to you asking you to update your previously entered Enrollment Questionnaire. The information from your prior questionnaire has been pre-populated for your convenience.

For new members, a full Enrollment Questionnaire will need to be completed. Please watch for an email from our National Coordinating Center and add this email to your acceptance list: CHR-NDPBRN-HUB@kpchr.org

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printed version of the Enrollment Questionnaire that was used from 2005-2019 is available for historical reference.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

As you may be aware, the Network has been funded to continue from 2019-2026 and we need updated information from our current members. An email will be sent to you asking you to update your previously entered Enrollment Questionnaire. The information from your prior questionnaire has been pre-populated for your convenience.

For new members, a full Enrollment Questionnaire will need to be completed. Please watch for an email from our National Coordinating Center and add this email to your acceptance list: CHR-NDPBRN-HUB@kpchr.org

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printed version of the Enrollment Questionnaire that was used from 2005-2019 is available for historical reference.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