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IL Miles of Smiles All Kids School-Based Dental Program Consent Form 2012 free printable template

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ALL KIDS SCHOOL-BASED DENTAL PROGRAM CONSENT FORM PLEASE PRINT IN INK DENTAL EXAM Services Rendered By: 309-382-6404 Miles of Smiles, Ltd. 137-C Radio City Dr. North Peking, IL 61554 MUST BE RETURNED
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IL Miles of Smiles All Kids School-Based Dental Program Consent Form Form Versions

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IL Miles of Smiles All Kids School-Based Dental Program Consent Form 2017
4.2 Satisfied (22 Votes)
IL Miles of Smiles All Kids School-Based Dental Program Consent Form 2012
4.7 Satisfied (47 Votes)

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How to fill out IL Miles of Smiles All Kids School-Based Dental

01
Obtain the IL Miles of Smiles All Kids School-Based Dental application form from your school's administration or their official website.
02
Fill in the required personal information for the child, including their name, age, and contact details.
03
Provide any necessary health information, such as allergies or existing dental conditions.
04
Complete the consent section, ensuring that a parent or guardian signs where required.
05
Submit the completed form to the designated school official or directly to the IL Miles of Smiles program coordinator.
06
Keep a copy of the submitted form for your records.

Who needs IL Miles of Smiles All Kids School-Based Dental?

01
Children in need of dental care who are enrolled in participating schools.
02
Families seeking accessible dental services for their children without financial burden.
03
Parents or guardians of children who may have difficulty accessing regular dental care.
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IL Miles of Smiles All Kids School-Based Dental is a program designed to provide dental services to children in schools throughout Illinois, aiming to improve dental health and access to care.
Schools participating in the program, along with dental providers offering services under this initiative, are required to file IL Miles of Smiles All Kids School-Based Dental.
To fill out the IL Miles of Smiles All Kids School-Based Dental, schools and dental providers must complete specific forms provided by the program, ensuring all required information is accurately reported.
The purpose of IL Miles of Smiles All Kids School-Based Dental is to enhance children's oral health by providing accessible dental care directly in the school environment.
Information that must be reported includes participant demographics, services provided, consent forms, and any follow-up care or referrals made as part of the dental services.
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