The Dental Clinic at the Knox County Community Health Center provides routine dental care for children and adults including:

• Fillings
• Sealants
• X-Rays
• Cleanings
• Extractions (including Wisdom Teeth!)
• Child Dentistry

 

We have a full-time dentist, oral surgeon,

dental assistants and dental hygienists!

 

   

Payment Policy

• Payment is due at time of service.
• Minimum payment for self-pay patients is $20 for Dental.
• If patients do not have health insurance, a sliding fee schedule at 200% above federal poverty guidelines is offered to all patients who are eligible. Need help getting coverage? Visit HealthCare.gov for easy steps to get health insurance. 
• Health Center staff can also assist patients with enrolling in health insurance or Medicaid if they qualify.
• We accept Cigna Dental, Delta Dental, CareSource, Molina and All Ohio Medicaid Plans.
• Patients are expected to pay the full sliding-fee-scale amount at the time of their appointment.
• KCCHC protects its patients from surprise medical bills for services and items provided by KCCHC through a combination of:
  • compliance with requirements established under Section 330 of the Public Health Service Act and
  • provision of Good Faith Estimates as outlined in Section 27966B-6 of the Federal No Surprises Act.  

 

Knox County Community Health Center is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).

 

Notice of Privacy Practices - HIPAA  

Sliding Fee Scale Chart

Visit Our Health Center

 

Paperwork

*NOTICE: By signing your name electronically and submitting the form(s), you acknowledge your electronic signature has the same legal validity as your manual signature.

Intake Packets

Intake Packet: Intake Packet 

Spanish Intake Packet - Versión en Español 

Other Forms

Sliding Fee Scale: SFS Application   Versión en español - Solicitud de escala móvil de tarifas

Records Release: Release Form TO  Release Form FROM  Versión en español - Publicación de registros

Unaccompanied Minor: Parent Consent to Treat  Versión en español - Consentimiento para tratar

Sports Physical: OHSAA Pre-Participation Physical Exam Forms  *If athlete is coming unaccompanied, PARENT/GUARDIAN needs to SIGN form before appointment

Special Clinic Forms

Please bring your completed Special Clinics form(s) - Additional intake forms are NOT needed.

 

COVID-19, Influenza, and School Vaccine Consent Form: Consent Form