Dental School Program

Dental School Program at River Valley Health & Dental

River Valley Health & Dental provides dental services to students within our local school districts. Students enrolled will be seen by staff at their respective schools on our Mobile Care Unit. Any student within the district is eligible for the program.

Enrollment forms must be completely filled out in order to serve students. These forms will collect insurance information and services will be billed accordingly. The responsible party is expected to pay the balance, if any, after insurance. If you do not have insurance, we offer a sliding fee scale discount program that discounts services based on income and household size, using the Federal Poverty Guidelines.

Dental Services Provided:
  • Dental Exams
  • Fluoride Varnish Treatments
  • Instruction For Oral Hygiene (Brushing, Flossing And Diet)
  • Dental X-Rays (Cavity Detection)
  • Tooth Extractions
  • Dental Screenings
  • Restorative Treatment (Fillings): Treatment to restore function, integrity and morphology of missing tooth structure.
  • Prophylaxis Treatment (Sealants): A thin coating applied to the chewing surfaces of teeth, forming a protective shield over the enamel to prevent decay
Check Out Our PDF Documents
Notice Of Privacy Practices
Patient Rights And Responsibilities

Dental Student Enrollment Form

Please Complete the Following Form to Enroll in the Dental School Program

    Medical History

    Parent/Guardian Contact Information

    Sign & Date

    Dental School Program Consent For Treatment

    This authorization and consent is intended to cover the delivery of dental care services to my minor child (referenced above) by RVH&DC.

    • I understand that this authorization will remain in effect with no expiration, unless revoked. I may revoke this authorization at any time, following the procedures outlined in the RVH&DC Notice of Privacy Practices.

    • I understand that by signing this authorization, I am giving RVH&DC the authority to provide treatment, including administration of medication, as necessary in the provider’s judgment.

    • I understand that the practice of medicine is not an exact science and no person has made a guarantee about the outcome of such care.

    • I reserve the right to refuse a specific treatment at any time.

    By signing below, I hereby consent to treatment by all RVH&DC providers, staff and others as may be involved in the dental care of my child in ways they judge are beneficial, to include exams, medication, and other dental treatments. Further, I understand that such treatment may be provided outside of my physical presence by the signing this consent.

    I understand I have full access to the following documents at any time online at www.rivervalleyhealthanddental.org:

    • RVH&DC Notice of Privacy Practices

    • Patient Rights and Responsibilities

    At any time, I can request a hard copy of these documents by calling River Valley Health & Dental.

    Communication is a very important aspect provided to the parent(s)/guardian(s) of students enrolled in the Dental School Program. Notification is given prior to all appointments and follow-up calls are made by River Valley Health & Dental staff, which includes information regarding referrals and/or additional treatment if needed.

    For more information, please contact Laura Bierly, PHDHP, Outreach Dental Hygienist, (570) 567-5400 ext. 1320

    Sliding Fee Scale
    Discount Program

    Apply Now

    This mobile unit is funded in part by: The Williamsport Lycoming Community Fund at First Community Foundation Partnership of Pennsylvania.