Application for Services

Medicaid Eligible Children (ages 3-19):

Parents or legal guardian, please print and complete the documents below and return to the Jefferson County Health Department-Arnold Branch. Upon receipt of all completed forms, you will be contacted to set up a dental appointment.

Uninsured Children (ages 3-19):

Parents or legal guardian, please print and complete the documents below and return to the Jefferson County Health Department-Arnold Branch. Upon receipt of all completed forms, you will be contacted to set up a dental appointment. Applications will not be considered if no proof of income is received. To see if you qualify, please refer to sliding scale fee.

Adults (Ages 20 and Up):

Unfortunately, we do not offer dental services for adults at this time; please see Clinic Referrals for assistance. (Link to clinics)

Return All Forms To:

Jefferson County Health Department-Arnold Branch
Attn: Dental Clinic
1818 Lonedell Road
Arnold, MO  63010 

Click for Forms