Get Eastern Oklahoma Donated Dental Services (e.o.d.d.s.) - Eodds

Filling out the Eastern Oklahoma Donated Dental Services (E.O.D.D.S.) application online can seem overwhelming, but this guide is here to help you through the process. Below, you will find step-by-step instructions to navigate each section of the form, ensuring you provide all necessary information for consideration of your dental care needs.

Follow the steps to complete the E.O.D.D.S. application form carefully.

1. Click the ‘Get Form’ button to access and open the E.O.D.D.S. form in an online editor.
2. Begin by filling out the Applicant Information section. Include your last name, first name, middle initial, address, city, state, county, zip code, primary and secondary phone numbers, emergency contact, and relation to the emergency contact. Specify your date of birth, social security number, race, and any mental or physical health issues.
3. Indicate your household income, the total number of persons living in your household, and the sources of income that apply to you. Make sure to include documentation proving your income, as this is required for all applications.
4. Describe your dental needs in detail, indicating if you require any teeth extractions. Provide information regarding any existing dental insurance or Medicaid coverage.
5. Read through the E.O.D.D.S. Patient Responsibility Contract and sign it to agree to the responsibilities outlined. Remember, failure to uphold these responsibilities can lead to termination from the program.
6. Complete the Acknowledgement of privacy practices form by signing and dating it, indicating whether or not you've received a copy of the notice of privacy practices.
7. Ensure you have all necessary documents ready, including proof of income and a formal referral letter from your case manager or partnering agency, if applicable.
8. Once all sections are filled out, review the application for completeness. After confirming all information is accurate, download or print a copy for your records, if necessary.
9. Mail the completed application along with all required documentation to the E.O.D.D.S. address provided in the form.

Start the E.O.D.D.S. application process online today to ensure you receive the dental services you need.