Contact Us: Future Smiles School Sealant Program

Thank you for your interest in the Future Smiles School-Based Sealant Program!

Please fill out this the this form and a member of our staff will contact you with further information.

Services We Provide:

Our prevention team of dental hygienists and dental assistants will go to where children are most frequently—our public schools. Our unique mobile delivery model breaks down the common barriers that hinder a child from seeing a dental professional. Portable dental units are wheeled into the school setting, which provides easy access to care and education while removing transportation barriers and lost school time.

✔ Oral health education and brushing supplies for the entire school
✔ Screenings
✔ Dental Sealants
✔ Fluoride varnish treatments
✔ Case management and referrals to a dentist

Your Name:*

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Your position/title: *

Your Email:*

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Phone Number*

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Name of location interested in services: *

Is this a:

School (elementary, middle or high)Head Start or PreKCommunity CenterOther

Please choose the services you are interested in receiving:*

	Yes	No	Not Sure
Oral health education and brushing supplies for the entire school
Screenings
Dental Sealants
Fluoride varnish treatments

Email AG

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Email CK

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