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Charitable Care Tracking Form

The Michigan Dental Association has developed a charitable contribution form for its members, which can be accessed using the links below. This form will help the MDA track charitable dental care performed by members across the state. The MDA encourages you to make copies of this form and to begin using it. It's very important that using this form becomes second nature to you and your staff. The form is easy to use with non-identifying basic information such as the local dental society where the charitable care was given, the patient's age, the ADA procedure code, and the value of the charitable care provided.

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Content of this section is viewable only by MDA members. If you’d like to join the MDA, please visit the Joining the MDA section for more information or call the MDA’s Josh Lord, Director of Membership and Strategic Initiatives, at 800-589-2632.

Michigan dentists can login in using their ADA number as their username but will be required to create their own password. Click on the "Forgot My Password" link to create your unique password.

Staff members registering for continuing education courses can search for and register under the doctor’s office (examples: Office of Dr. John Smith or Smith Family Dentistry). If you already have an account, log in using the username and password you created. Otherwise, create a new account and include your employer’s office name where requested.

If you have any trouble signing in using the new format, please contact us at 800-589-2632, or send an email to

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