How do I complete the Smiles 4 Canada application?

You can complete the online application. It has 7 parts:

  1. Patient Information Section: 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. You will be asked to provide a copy of your child's birth certificate.
  2. Financial Information Section: 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 need you to provide information on the income for all your child's parents/guardians and copies of the Canada Revenue Agency's Notice of Assessment, and your Full/Tax Return (T1 General Form that you submit your taxes to Canada Revenue Agency) for 2020 and 2021. If you are separated or divorced, you will be asked to submit a copy of your separation agreement or divorce decree that outlines the support payments being made from the non-custodial parent. The table below provides information on LICO.
Size of family unit
Rural areas
outside CMA or CA
Census Agglomeration (CA) Census Metropolitan Area (CMA)
Less than 30,000
(small towns)
30,000 to 99,999
(larger towns)
100,000 to 499,999
(small cities)
Over 500,000
(larger cities)
2021 After-tax family income
1 person 14,712 16,837 18,782 19,020 22,490
2 persons 17,906 20,493 22,861 23,149 27,373
3 persons 22,297 25,517 28,466 28,825 34,085
4 persons 27,816 31,835 35,515 35,962 42,523
5 persons 31,676 36,251 40,442 40,950 48,421
6 persons 35,129 40,204 44,851 45,415 53,700
7 or more persons 38,583 44,157 49,259 49,879 58,980
2020 After-tax family income
1 person 14,431 16,515 18,423 18,656 22,060
2 persons 17,564 20,101 22,424 22,706 26,849
3 persons 21,871 25,029 27,922 28,274 33,433
4 persons 27,284 31,226 34,836 35,274 41,710
5 persons 31,070 35,558 39,668 40,167 47,495
6 persons 34,457 39,435 43,993 44,546 52,673
7 or more persons 37,845 43,312 48,317 48,925 57,852

*2021 data is approximate, as it has not yet been released at time of publication


  1. 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 goals for the treatment.
  2. Digital Photos Guide: To help us evaluate the severity of your child's dental problems, we require that you send us 6 specific digital pictures; 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. Each photo must be uploaded separately during the application process. Please carefully follow all instructions in the photo guide.
  3. 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 submitted with the application.
  4. 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 publishing purposes. Each field must be completed in order for the form to upload.
  5. 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 based on a recent examination (after November 1, 2022) and share some basic dental health information with us. Please note: your dentist may charge for the completion of this form. A scan or photo of this form must be uploaded with the application.
  6. 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 the following link: [English or French]. Once you have all the information, you can complete it here.

Once you have started an application, you may find that you cannot complete it all at one time. You will receive an email with a link to the incomplete application where you may add any missing information. This information must be submitted by 11:59 pm ET on April 30th, 2023, and the link will deactivate on May 1, 2023.

The application must be completed in full, with all supporting documents uploaded, before it will be considered. Any applications still incomplete after April 30th, 2023 will NOT be considered.


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