Keep Veterans Smiling
Click to download the application form.

Download the application.

Our Day of Reciprocity on the third Tuesday each September allows us to treat basic dental issues including, cleaning, a filling, or an extraction. But we understand that many Veterans need more extensive treatment.

Annually, Veterans are selected to receive an extensive dental treatment plan, at no cost. Selections are made from applications submitted through the end of the last business day in October.

To submit an application complete the online form below and submit it electronically, or stop by our office during business hours and pick up an application to complete and return to us by the deadline.

Learn more about applications submitted for extensive dental treatment.

OFFICE LOCATION:
Dr. Sam's Premier Dentistry
1005 E. Sara Swamy Dr.
Sherman TX 75090

HOURS: Mon-Thurs 8AM-5PM, Friday 7AM-3PM

SCROLL DOWN THE PAGE TO SEE THE FORM..

Apply for Extended Treatment

Who is recommending this Veteran for treatment?

Who we contact for more information.
YOUR First Name
YOUR Last Name
Where can we call you if we have questions?
YOUR email address

Veteran's Information

VETERAN'S First Name
VETERAN'S Last Name
VETERAN'S Phone Number
VETERAN'S email
Tell us about your military service and anything we thing we should know to help us make a decision about selecting your application.
SELECTION PROCESS: Applications or recommendation may be submitted by the Veteran, his/her family, friend or a concerned citizen. Applications and recommendations received by the deadline will be considered on the basis of need and time required to perform the treatment. Applications and recommendations received after the deadline will not be considered. Treatment plans granted are determined by our professional staff selection process. All decisions are final.
If selected by our staff for extended treatment, we will ask you for your permission to use your image in any promotional advertising about the program, in the news media and/or social media. By checking the YES box below, you agree to allow this use.

Share this page with a Veteran