Dental Office Application With No Insurance In Allegheny
Category:
State:
Multi-State
County:
Allegheny
Control #:
US-00413-1
Format:
Word;
Rich Text
Instant download
Description
This form is an Employment Application. The form provides that applications are considered without regard to race, color, religion, or veteran status.
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You can visit any dentist that signs up with your MCO. Download, fill out, and print a paper application then send it to your local County Assistance Office.Allegheny County Area Agency on Aging partners with other agencies to offer you FREE, completely confidential, expert health insurance counseling. You may be eligible for financial assistance with your AHN bills if you: Have no or limited medical insurance. Are not eligible for Medicare or Medicaid. No insurance is needed. This is not a walk-in clinic. Please call first to discuss eligibility and to make an appointment. Fill out this form. 2. Sign and date it on page 1 and page 15. 3.