Only complete if your child is enrolled at a school where a dental van/clinic is currently located.
Once the form has been submitted successfully, a confirmation message will be displayed and you will receive a confirmation email if you have entered a valid email address.
Wide Bay Oral Health Service will then contact you for an examination / check up appointment for your child / children.
Note - a parent/legal guardian must attend with your child at the first appointment. (Step parents and grandparents can not sign at this 1st appointment unless they are the legal guardian.)
If more than 3 children please do another application for other children.
© The State of Queensland (Queensland Health) 1996-2021