Patient Information
PATIENT ELIGIBILITY REQUIREMENTS
Interfaith Dental Clinic provides dental services for low-income, working individuals who do not have dental insurance.
You must meet the following criteria to apply through the application process:
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Live in one of these counties: Cheatham, Davidson, Dickson, Robertson, Rutherford, Sumner, Williamson, or Wilson
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Work:
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Student or Single Parent: Must be employed and working a minimum of 20 hours per week
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Single Person: Must be employed and working a minimum of 30 hours per week
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Married and Head of Household: Must be employed and working a minimum of 30 hours per week
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Married but not Head of Household: Must be employed and working a minimum of 20 hours per week (unless children under age of 5 at home)
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If you are 65 or older and receive Social Security, a widow age 60 or over, or a caregiver not paid for providing care (example: adult child taking care of elderly parents on full time basis), you are not required to meet the working standards to qualify
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Do NOT have dental insurance (unless covered by TennCare or CoverKids)
Acceptance is based on above criteria in addition to total household income level and the number of individuals supported in the household
Our program is on a sliding fee scale. Patients receive a 50% to 80% discount off market value for services, based on income level.
If you meet the above requirements, please download and fill out our NEW PATIENT APPLICATION (English) or APLICACION PARA EL PROGRAMA (Espanol). Interfaith Dental Clinic of Rutherford County has begun accepting patient applications! If you qualify for the Interfaith Dental Clinic of Rutherford County, download the NEW RUTHERFORD COUNTY PATIENT APPLICATION.
This Application is in PDF Format, and requires Adobe Acrobat reader to open this file.
To Save this Application for later printing, Right Click the above link and choose the Save As Option.
| Attachment | Size |
|---|---|
| application_2012_-_middle_tennessee.pdf | 412.48 KB |
| complete_app_in_spanish_2011.pdf | 89.71 KB |
| application_2012-rutherford_county.pdf | 411.98 KB |
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