Child Eligibility

Your child can participate for FREE - no student is turned away

  • This program is provided free for all students, even if their families do not have dental insurance or if they find it financially difficult to provide preventive dental care for their children. 
  • This program is available to students whose families have trouble locating a dental home accepting their insurance.
  • This program is offered to students with private dental insurance who regularly see a dentist. Some families choose to supplement their child's regular dentist visits.

This program is available at your child's school

  • A registered dental hygienist will use portable equipment to perform preventative services.
  • This program is carried out in a confidential manner, and your health information privacy is respected in accordance with the Health Insurance Portability and Accountability Act (HIPAA).
  • The oral health care providers follow all guidelines set by the Center for Disease Control and Protection.

There are NO charges for these services to you or your school. IT'S FREE!

If your school is participating, you can fill out the Permission / Health History form and return it to your school as soon as possible. The consent form is valid for 1 year, and your child may be seen again for sealant re-checks, possible 6 month cleaning, and to receive up to 3 fluoride varnishes a year.

The demographic questions being asked on the permission form are requested by Wisconsin Seal-A-Smile and are for data entry purposes only. Please fill out as much as possible so they have a better understanding of the children receiving school-based dental services, which allows Wisconsin Seal-A-Smile to continue funding programs like Seals-On-Wheels Oral Health Program.

**A PDF of the Permission / Health History form can be downloaded or printed here**

Formulario de Autorización para Sellador Dental (Español)