Dental Office Application With Sliding Scale In Fairfax
Category:
State:
Multi-State
County:
Fairfax
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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To apply for the Sliding Fee Program, you must provide appropriate documentation. Applicants must provide customary forms as proof of income.Neighborhood Health provides dental care for patients of Neighborhood Health regardless of their insurance status. Dental Hygiene Clinic - . Oral Surgery Clinic - . Please call our office at for more information. Payment is based on a sliding scale according to income, marital status, number of children and dependents. To get sliding scale fee. Contact DentaQuest at 1- or search the DentaQuest website to find a listing of dentists who accept Medicaid in your zip code. Northern Virginia Dental Clinic. Fillings.