Affordable Dental Care · Website Donation Form

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Help Us Save Smiles!

Affordable Dental Care is dedicated to providing quality dental care to those in the gap who are uninsured or underinsured. We aim to increase access to essential dental care services and advance health equity through collective action.

Here is what your donation can power:

Amount *

$1,000 - 1 Root Canal and Crown to Save a Crucial Tooth

$500 - 1 Partial Denture

$250 - 4 Emergency Care Appointments

$100 - 6 Kid's Cleanings and In-Depth Oral Health Instruction

$50 - 2 Senior Cleanings; 1 Filling

$30 - 5 Fluoride Treatments; 2 Kid's Cleanings; 1 Extraction

Donation Schedule

Contact Information

Name

First Name

Last Name

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Address

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Address Line 2

City

State/Province

ZIP/Postal Code

Country

Add 3% to my total amount to help cover the payment processing fees