Accessible Oral Health ECHO Plus Interest Survey

Thank you so much for your interest in participating in Project ECHO's Accessible Oral Health - ECHO Plus Cohort. We're glad you're here! This program is designed to enhance oral health care for people with intellectual and developmental disabilities (I/DD) by focusing on the following objectives:

Build Kansas oral health professionals' confidence in serving people with intellectual and developmental disabilities
Increase knowledge and information surrounding oral health accessibility
Challenge oral health professionals in addressing stigma surrounding patients with I/DD

Please complete all fields in the interest survey below, and someone from our team will reach out to you with a confirmation email shortly after.

Reasons why you should join:

Learn and apply new skills and strategies in your clinic or community with the support of expert mentorship
Tackle stigma and create more inclusive, patient-centered care
Promote your commitment to accessible oral health with ready-to-use outreach tools

Please note that up to five practices will receive a stipend of $500 for their time and participation.

If you have any questions, please do not hesitate to reach out to us at projectecho@kumc.edu

Thank you!

Applicant ID

ECHO Role or ECHO team member

Practice/Organization Name:

* must provide value

Name of Contact Person:

* must provide value

Email of Contact Person:

* must provide value

Organization size; number of providers and staff

* must provide value

Organization size; patients served

* must provide value

Location by county:

* must provide value

Population Served: (e.g., demographics, primary focus, special populations)

* must provide value

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What does your organization hope to gain from participating?

* must provide value

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What barriers does your organization face with increasing accessibility for individuals with intellectual and developmental disabilities?

* must provide value

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Is your practice/organization currently involved in providing support to individuals with intellectual and developmental disabilities?

* must provide value

Yes

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Do you promote or market these services?

* must provide value

Yes

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Please briefly describe your marketing plan.

* must provide value

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Please briefly describe any other marketing or promotional activities used by your organization.

* must provide value

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Please briefly describe your organization's general marketing/promotional activities.

* must provide value

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Are there any other factors or considerations you would like us to know?

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.