Dental Health Services

Hours and Location

Office Hours
Monday - Wednesday & Friday, 8:00 a.m. - 4:30 p.m.
Thursday, 8:00 a.m. - 8:00 p.m.
Location
3140 N St, Lincoln, Nebraska 68510
Tel
402-441-8015

Please call for more information or to make an appointment.

Clinic Services Available

  • Emergency, routine and preventive dental services provided at reduced fees
  • Interpretation provided

Services for Children

  • For low-income children without dental insurance
  • For children between the ages of 1 and 18
  • For children covered through Medicaid

Services for Adults

  • For low-income adults without dental insurance
  • For adults covered through Medicaid
  • For low-income pregnant women without dental insurance, and/or presumed eligible for Medicaid

Eligibility for Dental Clinic Services

  • For Lincoln and Lancaster county residents
  • Federal income guidelines are used to determine eligibility and level of payment for dental services
  • Income guidelines are based on the total number of people living in the household and total household income
  • Proof of income according to Federal eligibility guidelines is required for determining eligibility for dental services
  • Special consideration may be given to those situations where unusual hardships occur
  • No family or individual will be denied dental services if unable to pay the minimum fee or sliding fee at the time of their appointment, but payment of fees is still expected
  • Individuals and families will be responsible for the timely payment of their dental fees and account balances, with payment plans accepted

Pre-Visit Dental Forms

Save time waiting in the clinic! Print form(s) and complete using black ink. Then, fax to 402-441-8142 or bring the completed form(s) with you to your dental appointment. A child health history must be signed by parent or legal guardian.

A child must be accompanied by a parent or legal guardian or an Authorization Consent and Appointment of Agent Form will need to be completed and presented with the client.

Pregnant clients will need an Authorization to Treat (Pregnant Client) form signed by their physician for dental treatment. Print the form, have your physician complete and sign the form and bring the completed form with you to your appointment.

Application for Dental Services Form

Complete one per household. Must be updated annually at minimum. Proof of household income must be provided at time of visit for eligibility of dental services. Full price dental fees will be charged if proof of income is not provided.

Health History Form

Complete one per patient. Update annually. Please bring a current list of your medications.

  • Arabic
  • English
  • Farsi
  • Spanish
  • Vietnamese
  • Authorization Consent and Appointment of Agent Form for Child

    Complete only if the parent or legal guardian can’t bring the child to the appointment. The form must be completed to allow them to have another person aged 19 or older bring the child to their dental appointment.

    Authorization to Treat (Pregnant Client) - Physician Signature Required

    Important Patient Information on Clinic Policy Regarding Dental Appointments

    Complete one per family.