Dental ACCESS Consent Form

If your child’s school participates in Kintegra’s Dental ACCESS Program, and you would like him/her to receive the preventive care provided in the Program, please print and sign the consent form below, and return it to your school’s office.

All care is provided at no cost to the patient.

For more information about Kintegra’s Dental ACCESS program, visit https://www.kintegra.org/dental-access-program-dentistry-at-schools/

Customer Support
613 E Franklin Blvd
Gastonia, NC 28054
Phone: 704-874-3316

Administrative Office
200 E. Second Avenue
Gastonia, NC 28052
Phone: 704-874-1900
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This health center is a FQHC Health Center Program grantee under 42 I.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).
Kintegra is an FTCA deemed organization that receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.