Patients
Get the smile you deserve.
Patient Eligibility
1. All applicants must be a low-income household and meet the current Federal Poverty Guidelines with no other means of paying for dental care.
2. Applicants must live within the following counties:
Adair, Cherokee, Craig, Creek, Delaware, Haskell, Latimer, Leflore, Lincoln, Mayes, McIntosh, Muskogee, Nowata, Okfuskee, Okmulgee, Osage, Ottawa, Pawnee, Payne, Pittsburg, Pushmataha, Rogers, Sequoyah, Tulsa, Wagoner, Washington
3. Applicants must meet at least one of the following program requirements:
60 years and older
Veterans
Receiving a Social Security Administration Check
Financial Hardship
Referral from one of our partnering agencies (a formal letter from your social worker is required):
Medical Access Programs, Women in Recovery, Family and Children’s Services, Housing Shelters and Programs, Mental and Behavioral Health Services
Apply Now
Applications are generally accepted through mail only. Special need requests for a digital copy can be made.
You can download and print the application below or contact us to have it mailed or faxed to you.
Applicants must complete each page of the application and include proof of income.
PLEASE MAIL ALL COMPLETED APPLICATIONS TO:
Eastern Oklahoma Donated Dental Services
9810 E 42nd St, Suite 210
Tulsa, OK 74146