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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 FOUR 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$12,880$28,980
2$17,420$39,195
3$21,960$49,410
4$26,500$59,625
5$31,040$69,840
6$35,580$80,055
7$40,120$90,270
8$44,660$100,485

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. Applications are accepted by appointment only. Please call the office to setup screening appointment.

If filling out online: Once you have finished it, download it to save your changes and then send the downloaded copy (with your information) to Clinic Director Alicia Branstrom (abranstrom@vinadental.org).

Click here to download the online/fillable eligibility form

If printing and completing: Please mail or drop off your completed application to VINA at 400 E. Grand River Ave., Brighton MI 48116.

Click here to download the printable eligibility form