This form must be completed correctly to proceed with an appointment. If you need help or would prefer a printed form to complete, please click here or email us and we can send it to you.
With assistance from the Federal Government, Medicare has introduced a Child Dental Benefits Schedule (CDBS) that provides children access to basic dental services from the ages of 2-17 years old. The entitlement is capped at $1,013 per child for every two calendar year period.
To be eligible, you or the child must be claiming one of the following benefits: Family Tax Benefits-Part A, Parenting Payment, Abstudy, Youth Allowance, Carer’s Payment, Disability Support Pension, Special Benefits or Double Orphan Pension. To enquire if your child is eligible, please contact Medicare on 132 011.
Once your child’s forms have been completed, we will individually check each child’s eligibility to see if treatment can be bulk billed through Medicare.
If your child is not eligible for the CDBS funding, Teeth on Wheels can offer a check-up, clean and fluoride treatment (and x-rays if required) for only $99. If you have Private Health Insurance, Teeth on Wheels will provide you with an invoice after your $99 payment to claim your refund.
Please choose if you or your child had/has any of the following medical conditions. If you select a condition, please supply any further information.
Please note: If you do not wish to have any treatments done, please notify the Customer Service department . If a treatment is not required for your child, we will not do the treatment.
I, the patient / legal guardian, certify that I have been informed:
By signing this form I, the patient/legal guardian certify that:
By signing this form I certify that:
37 O'Hea Street
Coburg VIC 3058
Call: (03) 9338 1191
Email: Click here