Mobile travels to any facility or event where its services are in need, providing
treatment for Denti-Cal and Healthy Families subscribers and, with available funding,
for the uninsured.
To arrange a Tooth Mobile visit, please follow the instructions
below. The process is simple and efficient, as we are anxious to bring our program
Contact Director of Patient Relations at Tooth Mobile, at (408)
244-6029 to schedule a
Application and Consent Form and the Patient Medical History Form (available in English, Spanish and Korean).
Photocopy and distribute both forms to all interested individuals.
and Consent Form [Spanish] [Korean]
Patient Medical History [Spanish] [Korean]
Fax the completed Application forms to Tooth Mobile at (408) 244-9553,
attention CarOline Hart. Or, you can mail them to Tooth Mobile, 1659 Scott Blvd.
Suite 4, Santa Clara, CA 95050.
Note: The Patient Medical History forms
will be available at the Mobile and can be completed by the patient before his
or her appointment.