All updated IHSA forms, including pre-participation examination forms, can be found at:

Dental Safari Company, a mobile dental corporation, travels to schools to provide dental wellness checkups, and urgent care treatment, for children of all ages (pre-K through 12th grade).

Next visit:

Eligible Children:

• Children with a Medicaid / All Kids Identification number - FREE

• Children who are on free or reduced lunch program - FREE

• Children with private insurance (per insurance)

• Child with cash payment (cash or check: $75 – includes exam, cleaning, fluoride, sealants as needed - pricing as of 2022)

PLEASE NOTE: If your child is in Kindergarten, 2nd, 6th, or 9th grade, the State of Illinois does requires a dental exam to be on file. This appointment fulfills that obligation.

Following your child’s treatment, a letter will be sent home indicating the treatment your child received during our visit as well as follow-up treatment he/she may need.

To take part in this service, please complete and return the Offline Consent Form to the school nurse, or better yet, Register Online and send your nurse an email so we know to look out for you.

If you have any questions, please contact the nurse's office.

Dupo CUSD 196 is excited to partner with SIHF Healthcare. At present, SIHF visits Dupo Jr/Sr High School on the 2nd Tuesday of every month. Appointments can be made by calling 618-578-5705. Bluffview students are required to be escorted by a parent or guardian for evaluation, treatment, and care. You can optionally choose to preauthorize treatment to allow your child to receive evaluation, treatment, and care.

Authorization to Treat a Minor Child

The SIHF Healthcare School-Based Program is a partnership with Dupo Community Unit School District No 196 to provide primary healthcare services. By completing this form and consenting for services, you are granting permission for the evaluation and treatment of your child. In addition, you are granting permission for the release of necessary information by both SIHF Healthcare and Dupo CUSD 196 for the purpose of documenting compliance with state requirements and for the planning and delivery of quality healthcare (e.g. basic health history, immunization records, and school and sports physicals). 

By completing this form, you authorize insurance payment of medical benefits to SIHF Healthcare and the release of personal/health information necessary to process insurance claims.

This consent authorization will remain valid and on file with SIHF Healthcare and the School-Based Program as long as your child is enrolled in Dupo CUSD 196.  You reserve the right to revoke this authorization at any time.