What do I bring?

If you have insurance, you will need to bring your insurance card. If you are uninsured, you will need to bring any of the following to show proof of income necessary for the Sliding Fee discount:

• Recent pay stubs for you and anyone else in the household who works
• Social Security or AFCD award letter
• If someone is helping you with food or rent, we need a notarized letter stating the amount of assistance you are receiving each month.
• If you receive food stamps, we need a print out from your caseworker with the amount you receive on a monthly basis.

NOTE: If you do not bring proof of income, you will be charged the full fee. You will be allowed 2 weeks from the date of your appointment to bring your proof of income and receive a discount according to your income.

Fill out this dental preregistration medical history form, and bring it to your first dental appointment.