2501 W. 18th Ave., Suite D
Emporia, KS 66801
620-342-1714 • Fax 620-342-4701

Medical Applicants

Dental Services

  • Fill out the online assessment form to see if you qualify for medical assistance
  • If the assessment is successfully completed, you will receive a download link for the full application

Orthodontics

  • Download Application
  • Administered through Smiles Changes Lives (SLC). Follow SLC’s instructions to print and mail your application.

General Medical

  • Fill out the online assessment form to see if you qualify for medical assistance
  • If the assessment is successfully completed, you will receive a download link for the full application

Eye Exams and Glasses