Mobile Dental Hygiene Services

Dental Hygiene Services for Residential Care Clients and Home Visits

In order for us to provide dental hygiene services to you or your family member we require some personal information and a consent form to be completed by the client or their power of attorney (POA).

Attached please find page one of our client chart, a medical history, a consent form and details on fees and payment. Please complete all forms to the best of your ability and include a list of all current medications. This list can usually be obtained easily from the nursing staff. If the client has a dentist on record please be sure to fill that in on the chart, as any additional dental needs may be forwarded to that dentist.

When completed, please return to our office page 1 of the client chart, 1 copy of the consent form and the medication list. Once our office has all forms returned, we will contact the POA or Facility to schedule an appointment.

The first visit will consist of a comprehensive new client exam. Following this appointment, our office will contact you with information regarding the oral health of the client, any recommendations for oral hygiene aids (provided at cost) and an estimate for the cost for dental hygiene treatment. We will also discuss the recommended time interval for maintenance dental hygiene appointments and complete a referral for any additional dental needs that may be required.

We are happy to answer any questions you may have regarding this program. Please feel free to contact our office at any time.

New Client Chart

Medical History

On Going Consent Form

Payment of Fees

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