Becoming a patient at the UF College of Dentistry DMD-Student Dental Clinic

Becoming a patient at the UF College of Dentistry

DMD-Student Dental Clinic

Thank you for your interest in becoming a patient with the college¡¯s DMD-Student Dental Clinic. In our clinic, DMD students

provide dental treatment under the close supervision of a faculty member in a professional learning environment. We

provide high-quality treatment at a reduced rate.

DMD-Student Dental Clinic patients must be willing to attend extended appointments, since the students are perfecting

techniques and may take longer than a practicing dentist. Also, we select patients through a screening process to ensure

that they¡¯re appropriate for the educational experiences our students need.

Screening

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There is a $30 fee for the screening appointment.

The fee covers the cost of the limited oral exam and

X-rays. A faculty member, experienced in selecting

patients that match the educational needs of our

students, performs the screening.

The fee is only paid if you are accepted to be screened as

a patient; please do not send any payment with your

application.

Screening doesn¡¯t guarantee your acceptance as a patient.

Please note: Only the patient is permitted in the clinic

during appointments. For the protection of children (or

adults with special needs) who are with you. There must

be adult supervision at all times.

Patient selection and appointments

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The enclosed form is a pre-screening form. Please

complete it and mail it back to us. Accepted applicants

will be contacted by an appointment coordinator.

Patient selection is based on matching the applicant¡¯s

needs to the student dentist skill level.

The students in the DMD-Student Dental Clinic need

to treat patients who need comprehensive (all-inclusive)

dental services and need procedures that range from

simple to moderately difficult: a combination of dental

cleanings, fillings, simple extractions/root canals, crowns,

bridges, and/or dentures.

If you are screened and not selected as a patient we will

notify you by mail.

Selected patients must commit to at least two,

three-hour appointments each month until the

treatment plan is completed or the patient is referred to

another dentist. The average time to complete treatment

can be 12 months or longer.

Fees

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The college does not provide free dental care.

DMD-Student Dental Clinic fees are generally less than in

private practice. Patients are required to pay for routine

care at each appointment.

Screening fees are non-refundable regardless of outcome

of screening appointment.

If you have an outstanding balance with any UF College

of Dentistry clinic, you will not be considered for a

screening appointment.

Other important points

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If you are screened and not selected for treatment with

the DMD-Student Dental Clinic, you may be referred to

the college¡¯s Faculty Practice, one of our graduate

programs, or be advised to contact a private practice

dentist.

For persons 13 years of age and younger, please

call our Pediatric Dental Clinic at 352-273-7643 for more

information.

For dental emergencies, consisting of pain, swelling

and fever, please call 352-273-6705 for information

about our emergency dental services, or seek care at

your nearest hospital emergency department.

If you and a family member or friend would prefer to

schedule your screening appointments together, we can

arrange that for the screening appointment only.

However, if you are selected as a patient, it is not likely

we can schedule your future dental appointments at the

same time as your friends and family.

Patients must show a valid photo ID and confirmation

of current mailing address at every appointment. If

your mailing address is different than what is on your

photo ID, you can confirm your mailing address with a

current utility bill.

Interested in becoming a patient with us?

Please complete the enclosed Screening Application and return by mail to:

UF College of Dentistry

DMD-Student Dental Clinic

ATTN: Screening

PO Box 100412 Gainesville, FL 32610-0412

University of Florida College of Dentistry l 1395 Center Drive l Gainesville, FL 32610 l dental.ufl.edu

Driving & Parking at the UF College of Dentistry

From l-75

Take exit number 384 off I-75. Turn onto Archer Road heading east. The UF College of Dentistry is approximately

three miles ahead on the left. Turn left on Center Drive (opposite main entrance to the VA Hospital). Go to the first

stop sign and turn left on Mowry Road. Go a short distance to the driveway on the left that goes between the two

parking garages, and Patient Parking is on your left.

From the Gainesville Regional Airport

When leaving the airport, turn right onto 39th Avenue and head west. Go straight until you reach 13th Street (also

called Hwy 441). Turn left on 13th Street. Go straight until you reach Archer Road. Veer right onto Archer Road. The

college is three blocks ahead on the right.

From Highway 441 South

Go straight until you reach Archer Road. Turn left on Archer Road. The college is three blocks ahead on the right.

From Hwy 441 North

Go straight until you reach Archer Road. Veer right onto Archer Road. The college is three blocks ahead on the right.

Parking

Parking is available in the garage across Center Drive from the dental building. Please see the map below.

Disabled parking is available in a lot just west of the dental building. To park in this lot you must display a state

disabled person parking permit. Visitors to the UF campus who display a state disabled person parking permit may

park in any meter space on campus and in the patient/visitor garage without paying a parking fee.

Parking

From Archer Road, turn onto

Center Drive.

Take a left at the first stop

sign onto Mowry Road.

Turn left and drive up a

hill between two parking

garages.

Patient parking is free.

Please ask for a pass after

your dental appointment.

(Garage 2)

ive

Walk over Center Drive via

the crosswalk and into the

dental building. Follow the

signs inside the lobby to your

dental center.

Patient

Parking

Garage

er Dr

Cent

Patient parking garage is

on the left. There are two

different levels to choose

from.

UF College of

Dentistry

SW

er

Arch

d

Roa

UF College of Dentistry

DMD-Student Dental Clinic

Screening Application

Thank you for your interest in the DMD-Student Dental Clinic Program. Please read the attached

information sheet before continuing. If you want an appointment for a screening exam, please complete

this form and return it by mail.

Please note: a screening evaluation does not guarantee acceptance into the program. Charges for the

screening appointment are not refundable.

_____________________

Today¡¯s date

__________________________________________________________________

Name

_____________________

Date of Birth

_____________________________________________________________________________________________

Mailing address

City

State

ZIPcode

( _____ ) _______ - ______________ ( _____ ) _______ - ______________ c

Home phone Other phone

Male

c

Female

1) Check all the dental services you think you need or want, or oral problems you think you have

(please make your best guess):

c

c

c

c

c

c

Dental cleaning

Upper complete plate/denture

Upper removable partial plate/denture

More than one filling

Dental implant

Root canal

c

c

c

c

c

c

Gum disease treatment

Lower complete plate/denture

Lower removable partial plate/denture

Crown (cap) bridge

Orthodontics (braces)

Teeth pulled

2) Have you ever been a patient at the UF College of Dentistry?

c

Yes

c

No

3) Is your schedule flexible enough to allow one or two, half-day appointments a month?

c

Yes

c

No

4) How long has it been since you saw a dentist for regular (not urgent) dental care?

c Less than 1 year c 1-2 years

c 3-5 years c More than 5 years

¡°My signature indicates that I have read and understand the accompanying information and, if accepted as a

patient, I agree to abide by the stated guidelines.¡± ____________________________________

Signature

Unsigned applications will not be processed

After completing this form, return it by mail to:

UF College of Dentistry

DMD-Student Dental Clinic

PO Box 100412

Gainesville, FL 32610-0412

Office use only

(19 DMD Screening Application June)

ATTN: Screening

RCVD ____/____/____

RVWD2: _____ ____/____/____

The fee is only paid if you are screened to

become a patient; please do not send any

payment with your application.

RVWD1: _____ ____/____/____

A R RSPN____/____/____ ___________________

University of Florida College of Dentistry l 1395 Center Drive l Gainesville, FL 32610 l dental.ufl.edu

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