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
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 Vaccine: COVID-19 Consent Form
Flu Shot: Flu Shot Consent Form
School Vaccines: School Immunization Clinic Consent & Demographics
