Sliding Fee Scale

Red Bird Dental is a National Health Service Corp (NHSC) approved site, which allows us to provide dental care to those who may otherwise be unable to afford services.  In support of this policy, RBD has developed a sliding fee schedule (SFS) based on household income and size.

Gross income is used to determine eligibility. Our application must be completed, which will provide the name, relationship to patient, date of birth, monthly income and/or employer of every individual in the household. This form must be signed, and accompanied by proof income, which may include tax returns, pay stubs, unemployment, or other benefits/income receipts, and or letters of income verification from employers. Approval of a completed application is honored for a period of six (6) months. If additional treatment is needed beyond the six month frame, submission of an updated application is requested. 

The SFS is based on income levels based on the current HHS Federal Poverty Guidelines. 
The following charges are excluded from eligibility for discount:

- Nitrous oxide
- Any cosmetic procedures (whitening, veneers)
- Any orthodontic procedures
- Any non-medically necessary procedures (determined by the professional opinion of treating dentist)

 Application (Download)





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