Toothbrush Kit Member Feedback Form

Please use this form to provide feedback regarding the toothbrush kit you received during your care visit.


Other languages and formats: You can get this document in another language, large print, or another way that is best for you. You can also have a language interpreter. Call 888-788-9821 (TTY/TDD 711).


Eastern Oregon Coordinated Care Organization must follow state and federal civil rights laws. We cannot treat people unfairly in any of our services or programs because of a person’s age, color, disability, gender identity, marital status, national origin, race, religion, sex or sexual orientation. ATENCIÓN: Si habla español, hay disponibles servicios de ayuda con el idioma sin costo alguno para usted. Llame al 1-877-605-3229 (TTY: 711). 注意:如果您說中文,可得到免費語言幫助服 務。請致電 1-877-605-3229(聾啞人專用:711)

Subscriber ID (also known as ID number) is on your EOCCO member ID card.

Please enter any items you would not like to see in the future, or select "No".

Select or enter value
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Please enter any items you would like to see in the future, or select "No".

Select or enter value
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