Toothbrush Kit Program
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Toothbrush Kit Program — 01/28/2022

Thank you for taking the time to provide feedback regarding your recent care visit!

Need another copy of the flyers you received? You can download them below:

Please keep in mind that by clicking the link below, you will be directed to a third-party website (Smartsheet) to complete the survey. Certain pieces of protected health information (PHI) will be requested to complete the survey. Smartsheet may retain the data you submit to complete the survey. You can view Smartsheet’s Privacy Policy Smartsheet Privacy Notice | Smartsheet. Information entered into this survey will be shared with EOCCO. You can view EOCCO’s privacy policy at If you prefer to share this information directly with EOCCO, please call Customer Service at 1-888-788-9821 to complete the survey over the phone.

By completing the survey, you acknowledge that you have read and consent to the privacy policies listed above.

Link to toothbrush kit program feedback form in English:

Toothbrush Kit Feedback Form (

Enlace al formulario de comentarios del programa del kit de cepillo de dientes en Español:

Formulario de Comentarios para Kits de Cepillos de Dientes (