To be seen here at the clinic you must live in Douglas County, Kansas, be without private dental insurance (we do accept HealthWave / Medicaid), and you must also meet income guidelines based on federal poverty levels. 

Our fees are set on a sliding scale based on your income and fees are due at the time of service.

Proof of Income Requirement

Though the Douglas County Dental Clinic provides dental services at a reduced rate, the services are not free.  In order to serve all of our patients better, proof of income is a requirement to be

• Check stubs from work
• Copy of last year’s tax form
• Copy of your vision card 
• Copy of benefits received (Social Security, unemployment benefits, etc.)

If you are unsure that your proof of income will qualify you for services, please give us a call at 785-312-7770 to discuss your situation.

If you are relying on a third party to pay for these services, they must meet the federal poverty guidelines and they must provide proof of income from the list above. 

Individuals over the age of 15 must first see the dentist for an examination and X-rays before any other appointments for non-emergency cleanings, fillings, etc. can be set.

We require that you fill out our paperwork and bring it in, along with a photo ID and proof of income and/or medical card, before we can set an appointment.  Click HERE to view and print out our new patient paperwork.  Bring the filled out forms to the clinic and we'll be more than happy to setup an appointment if you qualify to be seen here.  The document is formatted in Adobe Acrobat format.  If you don't have Adobe Acrobat Reader on your computer, please click HERE.

In order to be seen here, you must meet our income guidelines.  Starting in 2010, we are able to see patients that are at 250% of 2008 federal poverty guidelines as determined by the State of Kansas' SCHIP guidelines.  Our income guidelines are as follows:

For family units with more than 8 members, add $3,740, $5,610, $7,480, or $9,000 for each additional member.