FREE Dental Eligibility Check
Unsure whether your child is eligible to receive FREE Dental check and clean under Medicare Child Dental Benefits Scheme (CDBS), use this form to enter the details, and one of our team member will get back to you with the eligibility status.
School / Centre Name
*
School / Centre Suburb
*
Name of the Child (As shown on the medicare card)
*
First Name
Middle Name (Leave it empty if no middle name)
Last Name
Medicare Number
*
Please enter 10 digit medicare card number.
Individual Reference Number (IRN)
*
Please enter 1 digit IRN Number on the medicare card
Full name of the Parent / Guardian
*
Mobile Number
*
Required to send eligibility check outcome.
Signature
*
Please use your touchscreen or mouse to sign.
Date
*
-
Day
-
Month
Year
Automatically selects today's date.
Submit
Should be Empty: