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Medicaid Online Screening
**Por favor haga clic aquí para enviar este formulario en Español.**
Welcome to Smileworks Orthodontics! This page is designed for prospective orthodontic patients that have coverage through the Virginia Medicaid program to see if they are eligible to receive orthodontic treatment at our practice. Please be advised that there are 2 steps to the screening process. The first is for our practice and requires you to complete the form below from home. If we designate you as eligible, the 2nd step is for your insurance and requires you to come in to our practice for an appointment for orthodontic records. During this appointment, we will be taking photographs and 2 x-rays to submit to your insurance company. You will not be seeing Dr. Hussaini during this appointment. If your insurance approves coverage for your treatment, then we will schedule you an appointment with Dr. Hussaini to discuss your orthodontic treatment plan.
Please complete the information below for the patient that will be getting orthodontic treatment. We will then reach out to you and let you know what the next step will be for your treatment.