DENTAL SAFARI COMPANY

							                                                             [TODAY’S DATE]
PO Box 2314
Carbondale, IL 62902-2314
(618) 303-7319
Contact@DentalSafariCompany.com

Parents/Guardian:

DENTAL SAFARI COMPANY, a mobile dental corporation, travels to schools to provide
dental wellness checkups, and urgent care treatment, for children of all ages (pre-K
through 12th grade).

We are coming to [SCHOOL NAME] on [TREATMENT DATE].

DENTAL SAFARI COMPANY is a fully licensed, professional company that believes dental
wellness begins with a 3-part approach: Education, Treatment, and Prevention. On
[DAY OF THE WEEK], your child/children will receive a visual exam (no x-rays) by a
licensed dentist, a cleaning, Fluoride treatment, and sealants as needed.

Eligible Children:

            Children with a Medicaid / All Kids Identification number
            Children who are on free or reduced lunch program
            Children with private insurance (provide information)
            Child with cash payment (cash or check)
               ($68 – includes exam, cleaning, fluoride, sealants as needed)

PLEASE NOTE: If your child is in Kindergarten, 2nd, or 6th grade, the State of Illinois
does requires a dental exam to be on file. This appointment fulfills that obligation.

Following your child’s treatment, a letter will be sent home indicating the treatment your
child received during our visit as well as follow-up treatment he/she may need.

To take part in this service, please complete and return the consent form to the school
nurse by [RETURN TO NURSE DATE].

If you have any questions, please contact my office at [SCHOOL NURSE PHONE].

Sincerely,

[SCHOOL NURSE]
[SCHOOL NURSE PHONE OR E-MAIL]