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Patient Requirements and Registration Information
Requirements
· Individuals must live in Calumet, Outagamie, or Winnebago County.
· Individuals must have NO dental insurance.
· Individuals must have family income below 200% of federal poverty level or a Forward Card (Badger Care)
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Registration
· Patients must register in person before being given an appointment.
· Patients must bring proof of residence in one of the 3 counties such as a utility bill.
· Patients must bring proof of family income - Forward Card (Badger Care) or proof of family income (examples - last year's tax return, last 3 pay stubs, unemployment statement, social security statement.)
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Important Information
- CO-PAYS ARE REQUIRED AT EVERY APPOINTMENT AND MAY ONLY BE PAID IN CASH.
- You will be required to make a co-payment based on a sliding scale according to your income. The maximum co-payment for a regular appointment will be $25.00.
- Bring proof of your family income and residence if you have not been seen at the clinic in the past 3 months.
- Arrive 15 minutes early to each appointment to fill out necessary paperwork.
- If you miss an appointment you will not be seen for six months.
- Care may be provided by Marquette University School of Dentistry dental students or a Fox Valley Technical College dental hygiene student under the supervision of one of our local volunteer dentists.
Children
- Children under 18 must be accompanied by a parent or legal guardian at every appointment.
- Children must be supervised in the waiting area.
- Children not receiving treatment must remain in the waiting area. They may not accompany an adult or other child in the treatment room.
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