New Patients
Piedmont Regional Dental Clinic (PRDC) is a nonprofit dental safety net clinic. We accept Medicaid, a variety of commercial dental insurance coverages and Care Credit. Uninsured, low-income patients may qualify for reduced rates. To find out if your household qualifies for reduced fees, you will need to complete some new patient paperwork.
New Patient Paper Work
Hate waiting? Download your new patient paperwork now and have it ready for your first appointment. This saves you time and gets you in to see the dentist faster! Need help with your paperwork? Give us a call prior to your first visit and we’ll meet with you. It’s a good idea to bring a list of all of your medications including the name of the medication, the dose you are taking and the number of times a day you take the medication. Who is eligible for PRDC’s Affordable Care Program? PRDC’s Affordable Care Program offers significant discounts to patients from households living at or below 250% of the federal poverty level. An eligibility screening determines if your household qualifies for this program. Please bring proof of household income including all public assistance (see below) and a photo ID to the screening. Eligibility is based on the total number of people living in the household and total annual household income. For more information go to https://aspe.hhs.gov/poverty-guidelines
Affordable Care Program Eligibility Paperwork
Click here Affordable Care Program Application for a downloadable eligibility application. Click here Letter of Financial Support if someone is helping you financially.
What to Bring To PRDC
To qualify for the Affordable Care Program discounts, please bring proof of ALL household income for one month (this includes anyone living in the household with you) Examples of Household income include:
- Pay stubs for one month
- Food stamp award letter
- Proof of income letter
- Social Security statement
- Disability statement
- Current 1040 Federal income Tax Statement
What else will you need?
- A current photo ID ( anyone living in the household over the age of 18 must provide a photo ID)
- The name, phone and fax number of your family physician
- A list of your medications including the name of the medication, the dosage and the number of times a day you take the medication.
Where Is the Piedmont Regional Dental Clinic?
PRDC is located in the same shopping center as Tractor Supply and Orange Family Physicians.
13296 James Madison Highway Orange, Virginia 22960
Phone: 540-661-0008
Fax: 540-661-1070
E-mail: info@vaprdc.org
Facebook: Piedmont Regional Dental Clinic
Print and return the completed forms to PRDC
You may mail the completed forms to:
PRDC
13296 James Madison Highway
Orange, VA 22960
or drop them by the Clinic.