Dear Parent/Guardian:
The Jordan Valley Mobile Dental Clinic will be visiting our school to provide free, onside dental services to qualifying students December 1st through 3rd. The program is available to students K-12th, who have active Medicaid. Services include a dental exam along with x-rays and treatment if needed.
If you would like for your child to participate, please print out and fill out ALL of the attached forms/patient information, front and back. IMPORTANT: make sure to fill in your child’s MEDICAID NUMBER. If you do not have access to a computer or printer, please contact your student’s school nurse, secretary, or teacher for a hard copy to be sent home with them.
Appointments are limited so please return completed forms to the school nurse ASAP, and no later than November 24th.
Please contact the school nurse with questions at 417-759-2555
Sincerely,
Mandy Miller, RN Elementary School Nurse Ext. 215
Brandy Cantwell, RN Middle School/High School Nurse Ext. 426
Mobile Unit Patient Information and Consent Form (2020-2021)