[TODAY’S DATE]
7562 Old Rt 13 t Marion, IL 62959
(618) 993-8333 t (618) 993-8335 (fax)
Parents/Guardian:
Dental Safari Company, a mobile dental corporation, travels to schools to provide dental wellness checkups, and urgent care treatment, for children of all ages (pre-K through 12th grade).
We are coming to [SCHOOL NAME] on [TREATMENT DATE].
Dental Safari Company is a fully licensed, professional company that believes dental wellness begins with a 3-part approach: Education, Treatment, and Prevention. On [DAY OF THE WEEK], your child/children will receive a visual exam (no x-rays) by a licensed dentist, a cleaning, Fluoride treatment, and sealants as needed.
Eligible Children:
· Children with a Medicaid / All Kids Identification number
· Children who are on free or reduced lunch program
· Children with private insurance (provide information)
· Child with cash payment (cash or check)
($68 – includes exam, cleaning, fluoride, sealants as needed)
PLEASE NOTE: If your child is in Kindergarten, 2nd, or 6th grade, the State of Illinois does requires a dental exam to be on file. This appointment fulfills that obligation.
Following your child’s treatment, a letter will be sent home indicating the treatment your child received during our visit as well as follow-up treatment he/she may need.
To take part in this service, please complete and return the consent form to the school nurse by [RETURN TO NURSE DATE].
If you have any questions, please contact my office at [SCHOOL NURSE PHONE].
Sincerely,
[SCHOOL NURSE]
[SCHOOL NURSE PHONE OR E-MAIL]