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As of July 1, 2025, Idaho law requires CDH to verify the lawful presence of those applying for public benefits through our agency.

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As of July 1, 2025, Idaho law requires CDH to verify the lawful presence of those applying for public benefits through our agency.

The programs impacted by this change are:
  • Sliding fee discount for medical clinic or counseling services for those not on Medicaid
  • WIC, PAT, and NFP applicants who are not adjunctively eligible for Idaho Medicaid, SNAP, or TAFI
  • Individual permits, such as septic, food, childcare, or similar permits/licenses
    • Licenses and permits for food establishments
    • Licenses and permits for septic onsite, pumper and installer services

You can review the policy here and then complete the form below to verify your lawful presence online or you can visit one of our CDH offices to confirm in person.

Lawful Presence Online Forms: English | Spanish

WIC: English | Spanish

Cavity Prevention Clinic Permission Form

CDH logo
Sealants Clinic Permission Form

Cavity Prevention Clinic Permission Form

Your permission is needed for us to provide oral health services. Please fill out the permission form below. This program has no out-of-pocket cost to you. If your child has Medicaid or dental insurance, we will bill those insurances and accept what they pay as full payment. As we are a non-profit organization, this helps us serve more children.
Please indicate which services your child may receive
I consent to my child receiving Silver Diamine Fluoride (SDF) to help stop cavities that have started. I certify that I have read and fully understand the linked information sheet, and that all my questions have been answered.
Please see the SDF information sheet linked below before selecting.
Silver Diamine Fluoride (SDF) Info Sheet

Student Demographics

If school not listed, please call (208) 327-8612
Is your child taking any medications or does your child have any allergies including foods, medication, etc.?
Insurance(Must be Complete to Receive Services)
Is your child enrolled in Idaho Smiles or Medicaid?
Is your child covered by private dental insurance?
Insured Gender
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Parent or Guardian's Details

CDH provides WIC services to those who qualify.
Please scan the QR code for more information and to apply.

https://signupwic.com/

WIC Services Link

Permission

By singing, I give permission for my child to participate in the fluoride varnish program & receive preventive dental services including fluoride varnish treatment(s). I acknowledge I have the right to opt out of any services offered. I authorize the release of information on my child’s dental visit to CDH, Medicaid (Idaho Smiles) or other insurance companies as applicable. I authorize the CDH to bill Medicaid/Idaho Smiles & to obtain required billing information through any program within CDH if needed. I hereby authorize and direct payment of the dental benefits otherwise payable to me, directly to CDH. I authorize information to be shared between your school or Head Start and CDH. I acknowledge that I was given an opportunity to read/obtain the CDH Notice of Privacy Practices and Financial Policy which can be found here: