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Parent or Guardian,
Orland Park Dental Services and The Illinois Department of Public Aid have arranged for dental services for eligible children.

These services may include an exam, cleaning, fluoride treatment and sealants (a protective coating on the chewing surfaces of back teeth).

Licensed dentists, hygienists and assistants will come to your child’s school with portable equipment.

In order for your child to receive these services, you must provide all the information requested in the electronic form below, For your protection, you must sign the form electronically.



Paper based Dental Screening Permission Forms are available below.