DMD-Student Dental Clinic - University of Florida Health

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

? 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

? 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

? 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

? 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 garage is on the left. There are two different levels to choose from.

Walk over Center Drive via the crosswalk and into the dental building. Follow the signs inside the lobby to your dental center.

Patient parking is free. Please ask for a pass after your dental appointment.

Center Drive

UF College of Dentistry

Patient Parking Garage

(Garage 2)

SW Archer Road

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 Male Home phoneOther phone

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 Dental cleaning c Upper complete plate/denture c Upper removable partial plate/denture c More than one filling c Dental implant c Root canal

c Gum disease treatment c Lower complete plate/denture c Lower removable partial plate/denture c Crown (cap) bridge c Orthodontics (braces) c 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 ATTN: Screening PO Box 100412 Gainesville, FL 32610-0412

The fee is only paid if you are screened to become a patient; please do not send any payment with your application.

Office use only

RCVD ____/____/____

(19 DMD Screening Application June) RVWD2: _____ ____/____/____

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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