CDBS Check Eligibility

The information you provide will allow us to check if your child is eligible for the $1132 child dental benefits from the federal government.

Date

Childs Name

First Last

Date of Birth

Medicare Card Number

Card expiry date

Childs reference number on medicare card

School Child Attends

Untitled

I have Private Health Insurance I would like to use it

I don’t have Private Health Insurance but I would still like my child seen

I do not require this service

Parent/Guardians Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile Number

Signature

CDBS check eligibility