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Tooth Mobile at Your Community Center

Tooth 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 to you.

Step #1 Contact Director of Patient Relations at Tooth Mobile, at (408) 244-6029 to schedule a visit.

Step #2 Download the 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.

Application and Consent Form [Spanish] [Korean]

Patient Medical History [Spanish] [Korean]

Step #3 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.

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