Parents or Guardians,
CONSENT FORM RV MIDDLE SCHOOL INFO REEDE GRAY INFO
Your school will be hosting the Minnesota School Sealant Program, where your child has the opportunity to receive FREE or reduced cost preventive dental services at school. The School Sealant Day will be on: Friday, January 31, 2020.
A licensed dental professional will be offering sealants, cleanings, and fluoride varnishes to students in grades: 5-8.
If you have any kind of dental insurance, these services are completely FREE to you. We submit the procedures to your insurance and donate whatever portion they do not cover. If you do not have dental insurance, your child can receive these services at 70% off the usual rates.
Dental sealants, fluoride varnishes, and teeth cleanings are often provided in a public health setting due to the amazing benefits they provide at a low cost. Your child will be kept comfortable throughout these easy preventive dental services. The entire process takes less than 15 minutes. They even get to see the tooth fairy that travels with our program!
Your student is encouraged to participate in this annual program every year. If we saw your student last year, this will allow us to provide a cleaning and fluoride varnish which we recommended once every 6 months for kids. Sealants only need to be placed once for each adult molar tooth. If there is a new adult tooth erupted that needs a sealant it will be placed. If we did sealants previously for your student, they will be checked and touched up for free if needed. Please still check all three boxes on the consent form procedures to allow us to do this.
In order to be eligible to receive these services, you need to fill out this consent form with your child's information and return it to school. This form is due by: Monday, January 6, 2020.
If you are able, we prefer that you fill out the consent form online at www.schoolsealants.com/consentform
This helps us process things quicker and more efficiently so we can help serve more students in our state that need these services. Otherwise, please complete this paper consent form today and return it to school to make sure your child will be able to benefit from this great program.
Please note that we are only at schools for a limited time and have many children to help. Checking the boxes on the following page authorizes us to perform those services, but DOES NOT GUARANTEE they will be completed. We provide services as time allows. We will only submit the services that we are able to complete to your insurance.
Please allow the MN School Sealant Program 2-6 weeks for processing all the paperwork after the program is complete. We will send you an email in 2-6 weeks with the results of your student’s oral health screening, what procedures were completed and recommendations for follow up care with a dentist. If you want more information about this program, please visit www.schoolsealants.com.