Income-Based Discount Program

Dental work for as little as $25

In order for us to verify your current situation, you will need to bring in the following information.

Proof of Income:

We require the following from ALL members of the individual’s household. If you or ANY household member receives any source of income not listed below, you must provide that information as well. Please bring all/any of these documents with you to your appointment and our amazing staff will verify if you qualify for funding or sliding fee discounts.

-Child support

-Alimony

-Pensions/Retirement

-Self Employed: Taxes with Schedule C

-Rental Income. Taxes with Schedule E

-Social Security Benefits

-VA Benefits

-Award letter for SSI & Unemployment indicting weekly and/or amounts.

-Disability Income

-School Grants and Scholarships

-Most recent tax Return

Proof of Family Size:

We require a copy of your most recent tax return to verify all members of the household. If you are self-employed or receive rental income, the full 1040 form and schedules must be attached.

Identification:

–Driver’s License, State- issued ID, Military ID, Student ID

–Passport/Visa

–If not available: rental agreement, Property tax bill, or two (2) utility bills.

Medicaid or other insurance coverage:

Please bring your Medicaid card or other proof of insurance with you if you have dental insurance.