Free Dental Care Weekend RSVP
December 12–13, 2025 | 8am - 5pm
Location: Greeley Dental Care, 5214 W 20th Street, Greeley
Full Name
*
First Name
Last Name
Phone Number
*
E-mail
*
example@example.com
Preferred Contact Method
*
Text
Call
Email
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How many people are you bringing (including yourself)?
*
Are you planning to come Friday, Saturday, or either day?
*
Friday, December 12
Saturday, December 13
Either Day Works
Approximate Arrival Time:
*
Please Select
Morning (8–11)
Midday (11–2)
Afternoon (2–5)
Treatment Needs (Select all that apply)
*
Cleaning
Filling
Tooth Extraction
Other/Unsure
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Please check each box to confirm you understand:
*
I understand that services are provided free of charge by licensed volunteer dentists and hygienists.
I understand that treatment availability depends on capacity each day and that walk-ins will be seen on a first-come, first-served basis.
I understand that no sedation or advanced restorative procedures (such as crowns, implants, or dentures) will be performed.
I understand that if I experience complications or need additional treatment after the event, I will need to follow up with my regular dentist or healthcare provider.
Comments & Questions
Please enter any questions on your mind or concerns that you do not see listed on the form
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