APPLICATION FOR DENTAL SERVICESYou can download the Bethesda Health Clinic Application for Dental Services from the button below. This application includes the qualifications to become a dental patient, a list of the documents you must provide, the application, and Waiver of Liability for Treatment. Downloading, printing, reading and completing the application prior to visiting Bethesda Admissions is advisable. This will help ensure that you have all the information and necessary documents required to process your application. Bethesda Admissions is open Monday-Thursday, 10:00AM-1:30PM, on a first come first served basis.
HOW TO APPLY
HOW TO APPLY - STEP 1
Meet Patient Eligibility Requirements
- Low income adult
- 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
HOW TO APPLY - STEP 2
Prepare Your Documentation
- Completed application and waiver forms
- A current government-issued photo ID
- If applicable or available, a recent paystub dated within the last 30 days.
- If applicable or available, pages 1 and 2 of your latest filed tax return (form 1040)
HOW TO APPLY - STEP 3
Meet with our admissions team to determine your eligibility.
- You must appear in person at the clinic during admission screening hours.
- Children are not allowed in the screening room. Please make arrangements ahead of time.
- We do not always have a bi-lingual admissions consultant available. If you speak Spanish, please bring an English-speaking interpreter.
- Bring your paperwork from Step 2.