Little Lights Dentistry at Light of the World Charities, provides free dental care to uninsured children living in poverty.


Dental providers referral form

Dental providers, please print and fax our standard form. Consider using our confidential fax cover sheet.


Qualifications:

Little Lights Dentistry provides free dental care for children under the age of 18 who:

  • Are not covered by Medicaid, and

  • Have no dental insurance,

  • Have not yet graduated from high school, and

  • Meet income eligibility requirements (at or below 200% of the federal poverty level) as defined by the Florida Department of Health.

If you believe your child qualifies, please request an appointment using the form below or call us at 772-223-9781.

If your child does not qualify for our program, please click here for more information.

Request an Appointment

This does not guarantee an appointment; it provides information to help us to determine eligibility.

Child's Name *
Child's Name
Parent or Guardian Name(s) *
Parent or Guardian Name(s)
Parent or Guardian Phone *
Parent or Guardian Phone
Secondary phone (if possible)
Secondary phone (if possible)
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