Request a Smile


Submit a Smile Request Online

** Applicant must be a resident of NC or must be under medical treatment in NC to qualify for a Smile

We respond exclusively by email; please check our response on your email. We try to respond as quickly as possible. Please check your spam mail as well, sometimes it goes to that folder.

CONTACT US to request Liability Release and Authorization RE: Medical Information and Publicity Form (If physical form is preferred).

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