Dental cover

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

  • Fillings
  • SealantsState of the Art Panoramic X Ray Unit thank you 07022020
  • X-Rays
  • Cleanings
  • Extractions (including Wisdom Teeth!)
  • Child Dentistry

 

We have a full-time dentist, oral surgeon,

dental assistants and dental hygienists!

 

 

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 Packet

Intake Packet: Fillable Intake Paperwork

Spanish Intake Packet - PRINT ONLY (papeleo de admisión de pacientes - IMPRIMIR SOLO)Versión en Español - todos los servicios 

 

Other Forms

Medications List: Additional Current Medications Form      Versión en español - Lista de medicamentos adicionales

 

Sliding Fee Scale: SFS Application      Versión en español - ​Escala móvil de tarifas

 

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.
  • At the time your appointment is made, you will be told how much you can expect to pay. If for some reason we need to do a procedure that was not planned, and you cannot pay in full, a statement will be given to you. The remaining balance will need to be paid before another appointment can be scheduled.
  • 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.  

 

Appointments and Cancellations

  • New Patients need to be scheduled for an exam and x-rays before any appointments for restorations can be made.
  • If you cannot make a scheduled appointment, please notify us by phone, at least 24 hrs. in advance of the appointment. There is usually a waiting list of people needing an appointment, so if you can’t make yours, we would like to be able to offer the appointment time to someone else.
  • If you do not call 24 hrs. in advance to cancel an appointment, it will be considered a “missed” appointment and could delay or prohibit future appointments.
  • A missed appointment is any appointment in which the patient does not show up or call in advance to cancel or reschedule the appointment.

 

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

 

Health Center Oral Surgeon Banner 08312020