PATIENT REFERRAL
Specialized dental care for a loved one? We can help.
If you have a patient or loved one with an intellectual or developmental disability who could be served by the dental services that A Gift Of Smiles foundation provides, please fill out our referral document below. Our treatment coordinator will contact you when the application has been reviewed. We do not receive phone calls to update the status of applications.
ELIGIBILITY
Acceptance as a foundation patient is dependent upon meeting certain criteria including but not limited to:
- Adult or child must reside in the Central Pennsylvania area.
- The patient has a developmental and/or intellectual disability and is under the age of 30.
- Or the patient us under the age of 5 with severe dental decay
- While priority funding is given to those patients with limited financial resources who do not have private dental insurance, all applications are reviewed on a case-by-case basis.
- Completion and submission of the patient referral form.
