Applications are also available at the public health department 145 Rhone Street, Friday Harbor, WA or from the Family Resource Center on Market Street. Thank you for your interest in Fish For Teeth!
Please read before downloading an application. You will be asked to sign this acknowledgement before submission.
ACKNOWLEDGMENT OF FINANCIAL HARDSHIP
I understand the dental services offered today are for those who cannot otherwise afford dental care. I attest that the financial hardship of paying for such services would prevent me from receiving them. I further attest I have no discretionary income, no dental insurance, and no other financial means to pay for dental services at this time.