Home > Eligibility

Eligibility

VINA has a limited amount of openings for patient eligibility. Applications will be accepted by appointment only. Please contact VINA Dental at (810) 844-0240, Monday-Thursday 9:00 am-4:00 pm. Applications can be picked up at the VINA Community Dental Center during business hours at 400 E. Grand River Ave., Brighton, MI 48116 or printed from our website here.

Eligibility: Patients must meet ALL 4 requirements:

  1. Individuals must live in Livingston County for at least 6 months
  2. Individuals must be at least 18 years of age
  3. Families must have NO dental insurance or Medicaid
  4. Families must have an income at or below 225% of federal poverty level. This also includes public assistance, social security, and unemployment.
Family SizeFPL (100%)VINA Eligibility
1$12,490$28,102
2$16,910$38,047
3$21,330$47,992
4$25,750$57,937
5$30,170$67,882
6$34,590$77,827
7$39,010$87,772
8$43,430$97,717

Services Provided*:

  • Exams including oral cancer
  • Cleanings
  • Fillings
  • X-rays
  • Fluoride Treatments
  • Oral Surgery/Extractions/Biopsies
  • Dental Education Materials
  • Crowns

*Note: In general, Root Canals and Periodontal services are provided on a limited basis and alternatives may exist that may not be provided within the scope of this clinic.

Services NOT Provided:

  • Braces
  • Whitening
  • Cosmetic Dentistry
  • Sedation – IV or oral
  • Nitrous Oxide (Laughing Gas)
  • Implants
  • Bridges

Application Procedures:

  • Applications are accepted on a daily basis
  • Patients must complete the Eligibility Forms. You can print them to fill them out by hand, or fill them out electronically at the bottom of this page.
  • Patients will be required to pay a scheduling fee of $25.00 for each visit.
  • All appointments must be PREPAID
  • Patients must bring proof of residence in Livingston County (ie: utility bill, etc.)
  • Patients must bring proof of family income (ie: last year’s tax return, unemployment statement, or social security statement)
  • Patients must bring a Michigan photo ID

Important Information:

  • Update proof of “Family Income” (including spouse) and residence once per year.
  • Patients must arrive 15 minutes BEFORE every appointment
  • If patient misses an appointment, co-pay will not be reimbursed and patient will be put at the END of the wait list after another payment is made.

Children:

  • Children may not be left alone in waiting room and must be supervised at all times.

Submission:

Please complete the Patient Eligibility Paperwork below. Once you have finished it, download it to save your changes. You can then send the downloaded copy (with your information) to Clinic Director Alicia Branstrom (abranstrom@vinadental.org). Applications will be accepted by appointment only. Please call office to setup screening appointment.