Embedded Files
Fillable Community Dental Form.pdfCommunity Dental Program
Community Dental Program
Download this fillable form, complete, save, and email to Samantha.Stevens@ncsuvt.org
Copy of Hardship Waiver of Liability Form 1.1.21.pdfHardship Mileage Program
Hardship Mileage Program
If you or a family member has Medicaid or Dr. Dynasaur, you may be eligible for mileage reimbursement to and from medical appointments
Copy of Physician Referral Form Editable.pdfTransportation Referral Form
Transportation Referral Form
Complete and sign this form to apply for transportation to a medical trip over 100 miles away from your home
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