Dental Office Application With Sliding Scale In Alameda - Employment Application for Dental Office
Category:
State:
Multi-State
County:
Alameda
Control #:
US-00413-1
Format:
Word
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.
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés.
For your convenience, the complete English version of this form is attached below the Spanish version.
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Provides: General dentistry to kids up to 17 years of age. Fee: Medi-Cal, private insurance, sliding fee scale.The purpose of this policy is to define the eligibility criteria for the Sliding Fee Discount. ; Denti-Cal or sliding fee scale, no private insurance. Please enter your gross income (the amount received before taxes are taken out). Household income includes everyone in the home. We accept Medi-Cal and most private health insurances. Uninsured patients may also qualify for a sliding fee discount program. Eligibility: Ages: 0 and up. 4400 to ask about eligibility and sliding-scale fees and co-pays.