Dear Parent or Guardian:
The Marion County Public Health Department (MCPHD) Smile Mobile will be visiting your child’s
school soon. The Smile Mobile is a forty foot, fully equipped dental office that comes complete
with a reception/education area, a two chair dental treatment area, and a complete lab/
sterilization area. The Smile Mobile provides a mobile dental office for all children ages 18 and
younger. Our goal is to provide a positive dental experience and an opportunity for better oral
and overall health for your child.
The MCPHD Smile Mobile is staffed by a highly qualified, professional and friendly dental team
from the Marion County Public Health Department. The safety of your child is assured by ethical
standards of practice by staff and dental services that are provided in a safe, sterile and pleasant
environment. All dental instruments are sterilized or disposed of after each patient.
The MCPHD Smile Mobile provides dental examinations, x-rays, cleanings, fluoride treatments
and dental education during your child’s visit. If time allows, dental sealants are also provided.
Your child will be encouraged to brush and floss daily to maintain a healthy smile and teeth.
After the visit, a dental report from the dentist will be sent home with your child. The report
will inform you on what treatment was provided and what further treatment is recommended.
You will also receive a MCPHD Dental Services brochure listing MCPHD dental clinics where your
child can receive further recommended treatment or you may seek treatment at a dental office
of your choice. The dentist will contact you immediately regarding any urgent or emergency
recommended treatment.
There is an administration fee of $20 for your child’s dental visit. Medicaid and personal insurance
reimbursement are also accepted as payment. Please be sure to include your child’s Medicaid or
your personal insurance information with the attached registration and treatment consent form.
If you do not have Medicaid or personal insurance for your child, a mail-in payment request for
the $20 fee and a blue, self-addressed, return envelope will be sent home with your child. Money
will not be collected at the visit.
If you would like for your child to receive dental services from the MCPHD Smile Mobile, please
fill out, in full, the attached form regarding your child’s medical history, family physician and a
telephone number where you (or other adult family member) can be reached during the school
day. Please sign the form and return it to your child’s school immediately. Please do not send
money with the form or your child.
We look forward to serving your child’s dental health needs!
Sincerely,
The MCPHD Smile Mobile Dental Team
* In order for your child to receive services, please answer all questions in ink and return this
completed form to your child’s school.