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.
  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 Tax Return for 2016 and 2017. 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)
2017 After-tax family income
1 person 13,782 15,772 17,595 17,817 21,068
2 persons 16,774 19,198 21,415 21,685 25,641
3 persons 20,887 23,903 26,666 27,002 31,929
4 persons 26,057 29,822 33,269 33,688 39,835
5 persons 29,672 33,959 37,884 38,361 45,360
6 persons 32,908 37,661 42,015 42,543 50,305
7 or more persons 36,143 41,364 46,144 46,725 55,250
2016 After-tax family income
1 person 13,525 15,478 17,267 17,485 20,675
2 persons 16,461 18,840 21,016 21,281 25,163
3 persons 20,498 23,457 26,169 26,499 31,334
4 persons 25,571 29,266 32,649 33,060 39,092
5 persons 29,119 33,326 37,178 37,646 44,514
6 persons 32,294 36,959 41,232 41,750 49,367
7 or more persons 35,469 40,593 45,284 45,854 54,220
  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 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. Each photo must be uploaded separately during the application process.
  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 pubilshing purposes. Each field must be completed in order for the form to submit.
  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 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 here. 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 March 31, 2019, and the link will deactivate on April 1, 2019.

The application must be completed in full, with all supporting documents uploaded, before it will be considered. Any applications still incomplete after March 31, 2019 will NOT be considered.


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