How to Apply for Dental Services

Click on the Title to Download Your Noor Dental APPLICATION Form

DentalHelpAt the Noor Dental Clinic, volunteers work together to provide free dental care for uninsured, low-income individuals who qualify for the clinic’s services. To qualify, you must meet our eligibility requirements and provide the required documents.

SELECTION PROCESS … and WHAT ARE YOU REQUIRED TO DO?

1. Are you eligible? You should review our eligibility requirements below. Make sure you meet our requirements.
2. Complete the Noor Dental Clinic Application. You do NOT have to provide verification of income or proof of identity at this time.
3. PRELIMINARY ELIGIBILITY DETERMINATION. We will review your application. If you do NOT meet our requirements based on your statements on the Application form, we will notify you.
4. Eligibility Interview. Every month our staff will select applications for eligibility verification. You will be contacted to set up an appointment with us. On your scheduled appointment, you will be asked to bring in verification of your eligibility (see “What you must provide” below).
5. Dental Appointment. If you meet all eligibility requirements and have provided all necessary verifications, we will contact you for an appointment as openings become available in the coming months.

HOW TO APPLY

1. You must complete a Noor Dental Clinic Application form to apply for dental services.

ELIGIBILITY REQUIREMENTS

To be eligible:
1. You must not have any type of dental insurance including: private dental insurance, government provided dental coverage, MediCal , CenCal , or any other type of dental insurance.
2. Household income must not be more than 200% of the 2014 Federal Poverty Level for all household members (see chart below).
3. You must be 18 years old or older.
Note: Patients will be re-screened for Eligibility annually.