Child Dental Benefits Schedule Form
Child Dental Benefits Schedule Non-Bulk Billing Patient Consent Form
About this Program
The Child Dental Benefits Schedule (CDBS) is an Australian Government program that provides access to basic dental services, within a benefit cap, over a relevant two calendar year period. Services that receive a benefit under the CDBS include examinations, cleaning, x-rays, fissure sealing, fillings, root canals, extractions and partial dentures. The full list of services is available in the Dental Benefits Schedule. The Schedule includes an item number, description, benefit amount and
applicable restrictions for each service. Services can be provided in a public or private setting. However, benefits are not available for orthodontics, cosmetic dental or any services provided in a hospital.
A child is eligible for the CDBS if they are:
• 0-17 years old for at least one day that calendar year;
• Eligible for Medicare; and
• Receive a payment from Services Australia at least once a year, or have a parent, carer or guardian who receives a payment from Services Australia at least once a year.
Please complete prior to appointment.
Your personal information is protected by law, including the Privacy Act 1988 and the Australian Privacy Principles (APPs), and is being collected by your Dental Provider on behalf of the Department of Health, Disability and Ageing (the department) for the primary purpose of facilitating basic dental services under the Child Dental Benefits Schedule.
If you do not provide this information services will not be able to be provided to you under the CDBS.
By providing your personal information to your Dental Provider you consent to the department collecting this personal information about you from your Dental Provider. You can access the department’s APP privacy policy at https://www.health.gov.au/resources/publications/privacy-policy
The department can be contacted by telephone on (02) 6289 1555 or via email at [email protected].
The department will not disclose your personal information to any overseas recipients.