Client Eligibility Criteria

Disabled Clients must be physically or mentally disabled, low-income, drawing their Social Security Disability (SSD) or Supplemental Security Income (SSI). Clients may not have any savings accounts, CD'S, Trust accounts, IRA'S or any other means of paying for dental care.

Frail Elderly Clients must be 65 years of age or older and low-income. Clients may not have any savings accounts, CD'S, Trust accounts, IRA'S or any other means of paying for dental care.

All Clients must meet the current year Annual Federal Poverty Guideline.

E.O.D.D.S. may make exceptions if the client is in a life-threatening situation or extreme pain.

Form Downloads

Applications accepted by mail only!

(These forms will open a new window. You might need to enable pop-ups for this site)

NOTE: You need to fill out and send all three forms to be put on our waiting list.
FORM 1: EODDS PATIENT RESPONSIBILITY CONTRACT.doc
FORM 1: EODDS PATIENT RESPONSIBILITY CONTRACT.pdf

FORM 2: EODDS_application.doc
FORM 2: EODDS_application.pdf

FORM 3: AUTHORIZATION FOR ACCESS AND DISCLOSURE.doc
FORM 3: AUTHORIZATION FOR ACCESS AND DISCLOSURE.pdf