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APPLICATIONS

 

How to Apply 

Important

All applications must either be completed online or be completed in-person by appointment only.

Online Applicants

Step 1 

Meet Patient Eligibility Requirements

  • Low income adult (age 18-64)
  • Dental-only applicants can be 65+
  • Employed or perform an important unpaid job, such as being a caregiver, volunteer or participant in a self-improvement program (e.g. education, rehabilitation, etc.)
  • Uninsured or underinsured

Step 2 

Prepare Your Documentation

Scan or photograph the following documents and save them as JPG, PNG or PDF files. (Each file must be 2Mb or less in size.)

  • A current government-issued photo ID
  • A recent headshot
  • Your most recent paystubs
  • Pages 1 and 2 of your latest filed tax return (form 1040)
  • If 65+ and applying for Dental-only, your Social Security/Disability Awards letter

Step 3

Complete and Submit the Two Online Forms Listed Below

Note: Successful submission of each form will automatically open the next form.

Problems?

If you have problems in submitting these forms, please contact our Admissions department at (903) 596-8353 x127.

In-Person Applicants

Step 1 

Meet Patient Eligibility Requirements

  • Low income adult (age 18-64)
  • Dental-only applicants can be 65+
  • Employed or perform an important unpaid job, such as being a caregiver, volunteer or participant in a self-improvement program (e.g. education, rehabilitation, etc.)
  • Uninsured or underinsured

Step 2

Prepare Your Documentation

Collect together the following documents:

  • A current government-issued photo ID
  • A recent headshot
  • Your most recent paystubs
  • Pages 1 and 2 of your latest filed tax return (form 1040)
  • If 65+ and applying for Dental-only, your Social Security/Disability Awards letter

Step 3

Make an Application Appointment

  • Call Johana at (903) 596-8353 x120 to make an in-person application appointment.
  • Bring all the documents from Step 2 to your appointment.
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