School Nurse
Jody Gray, RN BSN

Jody Gray RN, BSN (207) 375-6961 (207) 241-4165 (Call or Text) Fax: (207) 910-6473 jody.gray@rsu4.org

Tooth Protectors E-Permission Form

By clicking on the link above you can complete an online permission form for your student to be seen by Tooth Protectors at school. Once the permission form is complete it is sent directly to Tooth Protectors. There are mandatory fields that MUST be filled in before the form can be submitted. It also allows you to quickly and easily attach a picture of your dental insurance card to the form. Upon completion of the E Permission Form for students who selected to Self Pay, there is an option to pay by credit card.

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