Get Il Miles Of Smiles All Kids School-based Dental Program Consent Form 2012

Filling out the IL Miles Of Smiles All Kids School-Based Dental Program Consent Form is an essential step to allow your child to receive dental services at school. This guide provides a clear and supportive process for completing the form accurately online.

Follow the steps to successfully complete the consent form.

1. Click the 'Get Form' button to access the consent form and open it in your document editor.
2. Begin by entering the name of the school where your child is enrolled in the designated field. This ensures the services rendered are linked to the correct institution.
3. Fill in the teacher's name and the grade of your child. This information helps the dental team to identify and handle your child's case efficiently.
4. Indicate your county in the appropriate field. This is important for local service coordination.
5. Select whether your child has a dentist by marking 'Yes' or 'No'. If 'Yes', provide the dentist's name and the exam date.
6. You will need to provide your child's legal name, birth date, address, gender, city/ZIP, and home phone number. Accurate information is crucial for identification and communication.
7. Answer whether your child qualifies for free or reduced meals and if they are enrolled in the 'Medicaid/All Kids' program by selecting 'Yes' or 'No'. If applicable, include your child's recipient ID number.
8. If your child is covered by private dental insurance, fill out the insurance information, including the name, address of the insurance company, plan or group number, and the employee's details.
9. Respond to the health history questions by circling 'Yes' or 'No' to indicate any conditions your child may have. Be thorough in listing any medications currently taken.
10. Provide your signature as a parent or guardian in the indicated area to authorize dental treatment. Include the date of signing to complete the form.
11. Once all sections are filled out, save your changes. You may also choose to download, print, or share the completed consent form according to your needs.

Complete your child's dental consent form online today.