Suggest Someone For RS Program

This form is to be completed by the referring Agency/Organization for qualifying individuals in need of dental assessment and care. Referrals will be considered and interviewed by Dr. W. Laurence Oliver and/or his staff before confirmation of acceptance for treatment. The referred individual must be dentally debilitated to such an extent that it hinders employment opportunities.

The individual being must be referred by a non-profit organization or they must apply through the Hope Center located at 3625 E Loop 820 S, Fort Worth · (817) 451-6288.

 

Click here for referral form