Get Program Eligibility

Filling out the Program Eligibility form is an important step in accessing dental care through the Texas Donated Dental Services Program. This guide aims to provide detailed, step-by-step instructions to ensure a smooth application process for users seeking assistance.

Follow the steps to successfully complete your application online.

1. Click ‘Get Form’ button to obtain the application and open it in your preferred document editor.
2. Begin by checking the qualification box that applies to you. You must meet at least one of the criteria specified regarding age or permanent disability. Ensure to provide the necessary proof of disability if applicable.
3. Fill in your personal information accurately, including your name, phone number, address, email, date of birth, and marital status. This information is essential for processing your application.
4. Provide detailed information about your dental needs and any dental insurance you may have. Indicate if you have traveled for treatment before and any specific dental problems you are facing.
5. Complete the medical information section carefully. Include any major disabilities and health problems, medications you are taking, and the name of your physician.
6. Outline your financial information by detailing your monthly income and expenses. This section helps determine your eligibility for the program based on your financial situation.
7. Review the medical release form carefully, initial each statement, and sign at the bottom. This ensures your consent for information sharing necessary for your application.
8. Finally, save your completed application, then download or print it. Mail your application to the Texas Dental Association Smiles Foundation at the address provided. Ensure you send it to the correct address to avoid delays.

Complete and submit your Program Eligibility application online today to take the first step towards receiving the dental care you need.