Dental Care Request Form

Dental Care applications are now being taken in person or by mail only. You may print the form by clicking the link below. Instructions are on the form.

Patients are selected based on need, not first come, first served.

Applications are taken in person from 8:30am to 2:30pm, Monday through Friday, in the Blessed Mother Teresa Health Center at 2450 N. Harvard Ave.

Mailed applications should be mailed to:

Catholic Charities Dental Center
P.O. Box 580460
Tulsa, OK 74158-0460

Please fill out this form ONLY if you are in need of comprehensive dental care or dentures.

THIS FORM IS NOT INTENDED FOR THOSE NEEDING EXTRACTIONS. For people needing immediate pain relief or extractions for dentures, no appointment is required. Please arrive between 3 pm and 3:30 pm on the 1st, 2nd and 3rd Tuesdays of each month for our extraction clinic. A limited number of patients will be seen, as determined by the dentist in charge, starting at about 5 pm.

Click here for a printable form in English. En Español.