This form is used to help our volunteers at the clinic with arranging dental appointments. This is a free clinic for people who live in Troup County and do not have dental insurance. If you meet these criteria, please fill out the entire form and a volunteer will reach out to you either via email or by phone. Please be patient it can take a while to get on the list. If you are in pain, please see your primary care provider or go to the ER or a walk-in clinic. They should be able to assist you while you wait to be seen by a dentist. Thank you.