Sign up for dental assistance!

We are here to help.

You served our nation. Now it’s our turn to serve you. At AAVD, our mission is to give free critical and life-saving dental care to you, our Veterans who can’t afford dental insurance or pay for your care. Check out our eligibility criteria here to see if you qualify for our services. Ready to sign up for care, click below to request dental assistance.

Ready to sign up for the
Adopt a Vet Dental Program?

Please fill out the form below to sign up for our services.

Name *

Email Address

Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code

Branch of Service

Marine CorpsArmyNavyAirforceCoast GuardNational Guard/ Air National Guard

What was your discharge type? *Please select the one on your DD-214.HonorableGeneral/ Under Honorable ConditionOther than HonorableBad Conduct

Did you complete at least 12 months of active duty service? *Yes or No?YesNo

DemographicsWhat is your ethnicity?White/ CaucasianAsianNative Hawaiian/ Pacific IslanderHispanic or LatinoAfrican AmericanNative AmericanUnknownPrefer not to sayDemographics

Do you have a primary care doctor?

When did you last see them?

What is your monthly household income? *

USD

How many people are in your household? *Please select the option that best fits your situation.1 (Self)23 or More.

Do you have dental insurance? *Please select yes or no.YesNo

Have you ever been convicted of a felony? *Please select yes or no.YesNoIf yes, please explain in the additional details block.

Are you currently taking any medications? *Please select yes or no.YesNo

Are you currently experiencing dental pain?Please select yes or no.YesNo

Are you currently receiving any public assistance? *Please select yes or no.YesNoMedicaid/ Medicare/ Food Stamps

Do you have a VA Social Worker? *Please select yes or no.YesNo

Additional Comments

How did you hear about AAVD?

Facebook/ InstagramEmailFriendsAt an eventVA StaffMy DentistNewspaperGoogle/ Yahoo/ Bing etc.Another Veteran Organization

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Need help connecting with other resources, please visit the Nevada Department of Veteran Services website to explore other resources available to you.