How do I complete the Smiles 4 Canada application?
You can download the application. It has 7 parts:
- Patient Information Form: This gives us some basic information about you, your child, and your family – primarily how to contact you and any other legal decision-makers in your child's life.
- Financial Information form: Smiles 4 Canada is targeted at lower-income families, specifically those whose total after-tax family income in the previous two taxation years is below the Federal Low Income Cut-Offs (LICO). To substantiate income, we ask you to provide information on the income for all your child's parents/guardians and a copy of the Canada Revenue Agency's Notice of Assessment. The table below provides information on LICO.
|Size of family unit||Community size|
outside CMA or CA
|Census Agglomeration (CA)||Census Metropolitan Area (CMA)|
Less than 30,000
30,000 to 99,999
100,000 to 499,999
|2016||After-tax family income|
|7 or more persons||35,469||40,593||45,284||45,854||54,220|
|2015||After-tax family income|
|7 or more persons||34,972||40,024||44,649||45,211||53,460|
- Personal Statement Form: We want your child's treatment to be successful, and an important part of that success is his/her motivation – the more emotional investment your child has in the treatment, the greater the likelihood s/he will work cooperatively with the orthodontist and see it through to completion. In this form, we ask your child to share with us his/her reasons for receiving treatment and your goals for the treatment.
- Digital Photos Guide: To help us evaluate the severity of your child's dental problems, we ask that you send us at least 6 specific digital pictures; you are welcome to send more, but we need these 6 in order to determine the need and the amount of work to be done. The treating orthodontist will also need this information, plus any x-rays s/he may take, to develop a course of treatment.
- Personal Reference Form: We ask that you submit a personal reference for your child, to help us understand his/her character. The reference is in the form of a letter, written by someone other than a relative, explaining how the child is affected by his/her teeth and smile, and what his/her character is. The letter is to be sealed, with the sender's signature over the seal, and is confidential.
- Program Rules, Expectations and Release Form: This form constitutes an agreement between you, CFAO Smiles 4 Canada and the treating orthodontist. In it, you agree to ensure your child keeps his/her teeth clean, maintains his/her oral health, complies with the orthodontic treatment (including keeping all appointments, wearing retainers and rubber bands (if necessary)), and has any additional dental work that may be necessary. It also specifies what is included in the treatment, and what you might have to pay for separately. Finally, you are asked to give your consent on a number of important privacy considerations, including the disclosure of financial and health information to the Regional Committee that reviews the application and to the CFAO, and the use of case information that may be used for educational or pubilshing purposes.
- Dental Examination Form: To undertake your child's treatment, we need to have a good understanding of his/her current and past dental health. To do so, we require your child's general dentist to complete this form and share some basic dental health information with us. Please note: your dentist may charge for the completion of this form.
- Application Checklist: This checklist helps you keep track of the various forms and whether they have been submitted.
To download instructions on completing the application, please click here. Once you have all the information, you can send it to us at:
Smiles 4 Canada
c/o 2800 14th Avenue, Suite 210
Markham, ON L3R 0E4
The digital photos can be included with the application on a memory stick or CD, or can be e-mailed to firstname.lastname@example.org.