Peoria Illinois All Kids Dental Program Enrollment
Dental Sealants & More
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Saturday, October 20th, 2018

Enrollment and New Patient Forms

This program targets students pre-school through age 17.  

Students are eligible if enrolled in the All Kids Program, qualified for the Free or Reduced Lunch Program, or insured by the Illinois Department of Healthcare and Family Services.

Eligible students can receive a dental examination, a dental cleaning and a topical fluoride treatment once during the calendar year and the placement of dental sealants in the permanent molar teeth once during their lifetime.  

A pre-printed permission form is sent to the parent of the student through the school (see Permission Form in this website). Eligibility is determined by the information provided on this form.  Eligibility of All-Kids recipients and those insured through the Department of Health and Family Services is confirmed through DentaQuest via internet connection.

Dental Sealants and More does not accept private dental insurance.  We encourage students to visit their family dentist regularly for preventive care. 

Once eligibility is established, the Illinois Department of Healthcare and Family Services, your County Health Department and Dental Sealants and More will arrange for your child to receive preventive dental services.  

If your child is eligible, the services may include:

  • A dental exam by a licensed dentist
  • Dental cleaning by a licensed hygienist
  • Topical fluoride application for cavity prevention
  • Placement of dental sealants in the permanent molar teeth as indicated
  • Education for dental health
  • A Dental Health Kit which includes a toothbrush, tooth paste and dental floss

Enrollment/Registration:

If you wish to have your child participate in this program, please complete the following form :

Permission Form – Return to your child’s school immediately!

Your child should have received a copy of this form to bring home.  If you did not receive one, you may download the permission form here.

1) Permission Form  (English Version)
Return to your child’s school nurse or secretary immediately.  If you cannot download the form, contact your child’s school nurse or secretary to receive one.
2) Permission Form  (Spanish Version)
 
Questions?  Call Sandy Lane at 309-339-9217

Serving Central Illinois
Since 1998

All Kids School-Based Dental Program
Dental Sealants and More

2126 N. University Street
Peoria, Illinois 61604
Phone: 309-339-9217

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