Dental Assistance/Dental Screening - Preschool 2023-2024
Does your Preschool child need a dentist?  

The Milton School 802 Smiles Dental Hygienist can assist you in finding a dentist. 

Has your Preschool child not been to a dentist for over a year?

The Milton School 802 Smiles Dental Hygienist will contact you to schedule a dental screening for your child at school.  


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Email *
Student's Name *
Student's Date of Birth *
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Student's Preschool Teacher *
Does your child have a regular dentist? *
Required
If "YES" your child has a regular dentist, please list the name of the dentist/dental practice (or type in "not applicable" or "none") *
If your child goes to Timberlane Dental, please indicate the location: *
Required
How long has it been since your child has seen a dentist? *
Required
Please indicate your dental insurance. *
Required
Optional: Share any dental concerns or dental questions you have about your child:
I would like to be contacted by the Milton 802 Smiles Dental Hygienist for assistance in finding a dentist who accepts my dental insurance.

 *
Required
I would like to be contacted by the Milton 802 Smiles Dental Hygienist to schedule time for me to bring my child in for a dental screening at the school.  *
Parent/Guardian Name *
Parent/Guardian's best phone number during the day *
Parent/Guardian's email address *
Today's Date *
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Thank you for completing this online form. 
Questions? Please contact Catherine Lavigne, Dental Hygienist at
clavigne@mymtsd-vt.org

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