GBASBecome a VolunteerVolunteer Dentist Procedures, Protocol, and Expectations

Volunteer Dentist Procedures, Protocol, and Expectations

  1. The Give Back a Smile (GBAS) office initially pre-screens patients by review of the submitted applications; however, you are responsible for making the final determination of eligibility based on the program guidelines. It is the patient's responsibility to call and schedule her/his consultation appointment. The purpose of your initial consultation is to determine if your GBAS patient fits the guidelines of the program. If you determine your patient does not fit the criteria, please contact GBAS at 800.543.9220 or email GBAS.
  2. All GBAS applicants are required to either pay a $20 application fee which also serves as a contribution to the Foundation or complete 10 hours of community service prior to GBAS application submission. This requirement is to encourage more investment in their dental treatment and to add a sense of value for the "gift" they may receive.
  3. The patient must have received the injuries to her/his smile-zone from an abusive, intimate partner or spouse; husband, wife, partner, boyfriend, girlfriend, someone applicant dated or had a child with, and has been out of an abusive relationship for at least one year. All other situations, even if traumatic, including, without limitation, patient’s injuries caused by child abuse, elder abuse, sibling abuse, caregiver abuse, parent abuse, violent attacks not related to intimate partner violence, stranger assault, or accidental injury, do not qualify and must be denied eligibility by the dentist. The cause of the qualifying injury is initially verified by an advocate based on the patient application.
  4. The GBAS Program Guidelines do not cover severe dental neglect, decay, jaw injuries, pre-existing gum disease, or orthodontic treatment. You, as the dentist, make the final guideline determination and have flexibility in deciding what treatment to complete in these specific areas.
  5. The program is designed to focus on standard of care-smile-zone dentistry, not full-mouth reconstruction. You are free to restore more than the injured area, if you wish, but this is not an expectation of the program and assistance with laboratory work or specialists fees cannot be guaranteed.
  6. The program guidelines do not allow for the repair or replacement of previous dental work, such as in a pre-existing root canal treated tooth, an implant placed in the injured area, or a fixed or removable prosthesis that has been lost or is ill-fitting. You have flexibility in deciding what treatment to complete in these specific areas.    
  7. 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.
  8. If laboratory work is needed, please work with your local laboratory(ies) to obtain a donation of the work needed. If your laboratory is unable to donate, please contact the GBAS office at 800.543.9220 or e-mail Give Back a Smile for a participating volunteer laboratory referral.      
  9.  In addition to disqualifications for eligibility reasons, you can also disqualify a patient from the GBAS program for all or any of the following reasons: failing to show up for appointments, cancelling appointments, or cancelling appointments without 48-hour notice. 
  10. Once your GBAS case is complete, submit the “GBAS Final Report” form by faxing it to 608.222.9540 or mail it to 402 West Wilson St., Madison, WI 53703. You will not receive credit for completing your case until this form is received by the GBAS office.
  11. When your GBAS case is complete and the “GBAS Final Report” form has been submitted, you are not required to perform maintenance to any of the dental work performed.  The GBAS case is closed and will not be reopened. 
  12. All GBAS patients are expected to be held accountable however, survivors of domestic violence may present long-term effects of violence. Be prepared for the possibility that your GBAS patient may exhibit these characteristics: depression, high risk of alcohol and drug problems, past and present, difficulty with accountability, inadequate hygiene, and difficultly with expressing appreciation of your time. 
  13. If you need to discontinue treatment for any reason, please contact the GBAS office immediately and we will guide you through termination protocol.
  14. 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.