Volunteer Dentist Guidelines
Thank you for your generosity in sharing your cosmetic dentistry skills with survivors of domestic or sexual violence. Please review the following:
- GBAS patients are prescreened based on the information provided on their application, however, you are the final step in the screening process and are responsible for making the final determination of eligibility based on your clinical perspective and the program guidelines.
- If you determine your patient doesn't fit the criteria or if you receive disqualifying and or conflicting information during the patient's consultation appointment, please contact GBAS as soon as possible at 800.543.9220 or email GBAS.
- It is your patient's responsibility to call and schedule her/his consultation appointment. Please inform the GBAS office if your patient does not schedule her/his consultation appointment within 30 days.
- All applicants are required to either pay a $20.00 application fee or complete 10 hours of community service prior to application submission. This requirement is to encourage investment in their dental treatment and to add a sense of value for the "gift" they may receive.
Is your patient eligible?
- GBAS applicants must be at least 18 years old, who have received dental injuries from:
- Former intimate partner or spouse (husband, wife, boyfriend, or girlfriend)
- Family member
- Sexual violence
- Other violent attacks or accidental dental injuries, while traumatic, do not qualify
- Depending on their situation:
- The patient must have been out of all abusive relationships for at least one year
- Have lived in a separate home from the abusive family member for at least one year
- The sexual assault happened at least one year ago
- The GBAS program guidelines do not cover severe dental neglect, decay, jaw injuries, pre-existing gum disease, or orthodontic treatment.
- The program guidelines do not allow for the repair or replacement of previous dental work, such as dental work that does not fit, looks bad, no longer works, or an implant that was started but not completed.
- In addition to disqualification for eligibility reasons, you can also disqualify a patient from the program for all or any of the following reasons: failing to show up for appointments, excessively cancelling appointments, or cancelling appointments without 48-hour notice.
- NOTE: You, as the dentist make the final determination and have flexibility in deciding what scope of treatment to complete in these above specific areas.
Specialist and laboratory info
- The GBAS program does not guarantee specialist referrals, i.e. implants, orthodontics, or oral surgery procedures. If you are able to perform these procedures or can engage a specialist with whom you work to donate these services, please feel free to coordinate your treatment plan. NOTE: Funding is available to support these expenses.
- If laboratory work is needed, please work with your preferred laboratory(ies) to obtain a donation of the work needed. If your laboratory is unable to donate, please contact the GBAS office for a participating volunteer laboratory referral. NOTE: Funding is available to support laboratory material expenses.
When you finish your case
- Once you have completed your GBAS case, please submit the Final Report Form by:
- faxing to 608.222.9540
- Mailing to GBAS, 402 West Wilson St, Madison, WI 53703
- Emailing to GBAS
- When your case is complete, you are not required to perform maintenance to any of the dental work performed. Your patient will be informed of the donated value of her/his dental treatment and that her/his case is closed and will not be reopened.
Other important info
- All GBAS patients are expected to be held accountable however, some survivors of violence may present long-term emotional/behavioral effects even years after the trauma. If you have any concerns while working with your patient, please contact the GBAS office right away so we can provide the necessary volunteer support.
- If you need to discontinue treatment for any reason, please contact the GBAS office immediately and we will guide you through the termination process.
- By participating in the GBAS program, you, at your sole cost and expense, are agreeing to (i) comply with all insurance requirements and with all laws, statutes, ordinances and regulations, including without limitation, any ethical guidelines, of Federal, state, county and municipal authorities which shall impose any duty upon you with respect to the GBAS program or your services thereunder; (ii) indemnify, covenant, defend and hold GBAS harmless from and against any damage, liability, loss, cost or deficiency, and the reasonable fees, disbursements and expenses of attorneys and other professional advisors), directly or indirectly, arising out of, resulting from or relating to your failure to duly perform or observe any term, provision, covenant or agreement to be performed or observed pursuant to the GBAS program; (iii) carry any and all insurance as would be prudent under the circumstances; and (iv) be solely responsible for any and all treatment decisions made with respect to your patient.
- If you approve your case, the HIPPA form must be signed by you and your patient and returned to GBAS.