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Patient Information
Patient Eligibility Requirements
- Income Requirement: Your household income must be at or below 200% of the Federal Poverty Level. Household includes anyone related by blood or marriage living in your home.
- Dental Coverage: Patients must not have dental coverage, including private dental insurance or Medicaid.
- Proof of Income: Each patient must provide documentation of individual and household income. Accepted forms of income verification include four recent paycheck stubs, a Social Security Award Letter, pension or retirement verification, or other official income statements.
- Proof of Identification and Residency: Each patient must provide a valid driver’s license or Florida state ID showing a current Pinellas County address.
- Review and Approval: All submitted paperwork will be reviewed by our staff. Patients will be notified once their application is approved, after which an appointment may be scheduled.
Patient Guidelines
Arrive on Time
Arriving on time helps ensure you receive your full treatment as planned and keeps your care on track without delays. Each appointment reserves a room, provider time, and resources specifically for you. If you need to make a change, please give at least 24 hours’ notice so we can offer that time to another patient in need.
- Missed appointments may delay your treatment progress and ability to complete care.
- After repeated missed appointments, future scheduling may be limited.
- If you arrive more than 10 minutes late, we may need to reschedule to ensure safe and complete care.
Confirm Your Appointment
As a courtesy, our office will contact you one to two days prior to your scheduled dental appointment to confirm. We may reach out by phone call or text message. If a message is left, please return our call or reply to the text to confirm your appointment. It is highly recommended that you save the clinic phone number to your phone.
Patients are responsible for maintaining current contact information to ensure timely communication regarding appointments, treatment, and office updates. Messages may be left after business hours, and our team will respond as soon as possible. Appointments that are not confirmed 24 hours’ in advance will be forfeited and will need to be rescheduled.
Missed Appointment Policy
A $25 fee will be charged for any missed appointment without prior notice (no-call/no-show). This fee must be paid in full before scheduling any future appointments.
To avoid this charge, please notify our office of any changes or cancellations at least 24 hours in advance.
As a non-profit organization, this policy helps us make the best use of our limited resources and ensures our providers can serve as many patients as possible.
Participate in Your Treatment Plan
Your treatment plan is designed to help you achieve healthy teeth and gums as efficiently as possible. Following your recommended plan and attending scheduled visits helps prevent complications and reduces overall treatment time.
If you ever have questions or concerns, we are here to help and can arrange time for you to speak with our Dental Director. Working together ensures the best possible outcome for your care.
Respect Staff and Volunteers
Our providers and staff generously give their time to deliver quality care at no cost to you. A respectful and positive environment helps us provide the best experience for everyone.
If you have concerns, please let a team member know. We are happy to listen and help.
If you are referred to an outside provider, completing that appointment is an important part of your treatment. Missing outside referrals may delay your care and limit future referral options.
Clinic Rules
These guidelines help us maintain a safe, comfortable space for your care:
- Only patients are allowed in treatment areas (assistance available upon request for special needs).
- Please silence your phone during treatment to minimize interruptions.
- To protect patient privacy, photography and audio or video recording are not permitted within the clinic.