DOH-Collier County Tooth Time Request Form - Florida Department of Health in Collier County

Please use this form to request DOH-Collier Tooth Time and submit it with as much notice as possible. Your request will be responded promptly.

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead contact these offices by phone or in writing.

Name

This field is for validation purposes and should be left unchanged.

Name of Event or Organization:(Required)

Preferred Date:(Required)

Alternative Date:(Required)

Event Location:(Required)

Indoors

Outdoors

Address:

Street Address Address Line 2 City State ZIP Code

Setup Time:

Event Begins:

Event Ends:

Expected Audience Age:

Number of Expected Attendees:(Required)

Contact Person:

Additional Information: