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.
Thanks to Delta Dental Oral Health of Oklahoma Charitable Foundation EODDS has limited special funding
annually to provide denture/partial dentures only to low-income eastern
Oklahomans who live in the (918) and (539) area code region and don't meet our regular
guidelines. All other dental work must be completed.
Please call the EODDS office for an application or please download one and
mail in.
Thanks to the George Kaiser Family Foundation and the J.A. and Leta M. Chapman
Charitable Trust EODDS has added a Vulnerable population program (Program II).
EODDS will be providing services to women in the Healthy Women/Healthy Futures
Program, Women in the Alternatives to Incarceration Program, Tulsa Medical
Access Programs. If you are referred to EODDS by any of these programs please
download the referral application that has Vulnerable Population Program and
include the patient responsibility contract and the Authorization for Access and
Disclosure form and mail all three to the EODDS office. Thank you
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_application.doc
FORM 1:
EODDS_application.pdf
FORM 2:
AUTHORIZATION FOR ACCESS AND DISCLOSURE.doc
FORM 2:
AUTHORIZATION FOR ACCESS AND DISCLOSURE.pdf
FORM 3:
EODDS PATIENT RESPONSIBILITY CONTRACT.doc
FORM 3:
EODDS PATIENT RESPONSIBILITY CONTRACT.pdf
Vulnerable Population Downloads
Applications
accepted by mail only!
(These forms will open a
new window. You might need to enable pop-ups for this site)
NOTE: this form is for Vulnerable Population Applicants ONLY!
FORM 1:
Vulnerable Population Application.doc
FORM 1:
Vulnerable Population Application.pdf
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