Dental Health Services

Office Hours	Monday - Wednesday & Friday, 8:00 a.m. - 4:30 p.m.
Location	3131 "O" Street, Lincoln, Nebraska 68510
Telephone	402-441-8015

Please call for more information or to make an appointment.

Clinic Services Available (Interpretation services provided)

Services For Children

For low-income children without dental insurance
For children between the ages of 1 and 18
For children covered through Medicaid

Services for Adults

For low-income adults without dental insurance
For adults covered through Medicaid
For low-income pregnant women without dental insurance, and/or presumed eligible for Medicaid

Emergency Dental Clinic

SCOPE OF URGENT CARE FOR PAIN AND/OR INFECTION:

LIMITED FOCUS EXAM
EXTRACTIONS
FILLING
REFERRAL TO OTHER COMMUNITY RESOURCES FOR DENTAL NEEDS THAT ARE BEYOND OUR SERVICES OR ELIGIBILITY REQUIREMENTS
INTERPRETATION SERVICES PROVIDED

PATIENTS SERVED:

LANCASTER COUNTY RESIDENTS
UNINSURED, LOW-INCOME ADULTS ON A SLIDING FEE SCALE WITH PROOF OF INCOME
MEDICAID ENROLLED
NO THIRD-PARTY INSURANCE OR NO DUAL MEDICARE/MEDICAID COVERAGE ACCEPTED
SLIDING FEE PAYMENT EXPECTED AT TIME OF SERVICE
CASH, CREDIT CARDS, OR CHECKS ACCEPTED

Call for an appointment - 402-441-8015

FRIDAY URGENT CARE APPOINTMENTS:

A LIMITED EVALUATIVE EXAM FOR THE ASSESSMENT OF PAIN AND INFECTION
EXTRACTIONS CAN USUALLY BE DONE SAME DAY OF LIMITED EXAM
FRIDAY WALK-INS ACCEPTED ON A SLIDING FEE WITH PROOF OF INCOME AND ON A FIRST COME FIRST SERVE BASIS UNTIL A FULL SCHEDULE

LIMITED DENTAL EXAM AVAILABLE OTHER DAYS OF WEEK WITH A SCHEDULED APPOINTMENT

WALK-IN FRIDAY CLINIC HOURS:

8 AM – 10:45 AM WITH LAST APPOINTMENTS AT 11 AM
CLOSED FOR LUNCH 12 PM – 1 PM
1:00 PM – 2:45 PM WITH LAST APPOINTMENTS AT 3 PM

Eligibility For Dental Clinic Services

For Lincoln and Lancaster county residents
Federal income guidelines are used to determine eligibility and level of payment for dental services
Income guidelines are based on the total number of people living in the household and total household income
Proof of income according to Federal eligibility guidelines is required for determining eligibility for dental services
Special consideration may be given to those situations where unusual hardships occur
No family or individual will be denied dental services if unable to pay the minimum fee or sliding fee at the time of their appointment, but payment of fees is still expected
Individuals and families will be responsible for the timely payment of their dental fees and account balances, with payment plans accepted

Pre-Visit Dental Forms

Save time waiting in the clinic! Print form(s) and complete using black ink. Then, fax to 402-441-8142 or bring the completed form(s) with you to your dental appointment. A child health history must be signed by parent or legal guardian.

A child must be accompanied by a parent or legal guardian or an Authorization Consent and Appointment of Agent Form will need to be completed and presented with the client.

Pregnant clients will need an Authorization to Treat (Pregnant Client) form signed by their physician for dental treatment. Print the form, have your physician complete and sign the form and bring the completed form with you to your appointment.

Application for Dental Services Form

Complete one per household. Must be updated annually at minimum. Proof of household income must be provided at time of visit for eligibility of dental services. Full price dental fees will be charged if proof of income is not provided.

Health History Form

Complete one per patient. Update annually. Please bring a current list of your medications.

Arabic / عربي

English

Farsi / سی

Spanish / español

Authorization Consent and Appointment of Agent Form for Child

Complete only if the parent or legal guardian can’t bring the child to the appointment. The form must be completed to allow them to have another person aged 19 or older bring the child to their dental appointment.

Important Patient Information on Clinic Policy Regarding Dental Appointments

Complete one per family.

Authorization to Treat (Pregnant Client) - Physician Signature Required(PDF, 106KB)