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 2018 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)
2019 After-tax family income
1 person 14,472 16,563 18,477 18,711 22,125
2 persons 17,615 20,160 22,490 22,722 26,927
3 persons 21,935 25,102 28,003 28,357 33,531
4 persons 27,364 31,318 34,938 35,377 41,832
5 persons 31,161 35,663 39,785 40,285 47,634
6 persons 34,558 39,551 44,122 44,677 52,828
7 or more persons 37,955 43,438 48,458 49,069 58,021
2018 After-tax family income
1 person 14,051 16,081 17,939 18,166 21,481
2 persons 17,102 19,573 21,835 22,109 26,143
3 persons 21,296 24,371 27,188 27,531 32,554
4 persons 26,567 30,406 33,920 34,347 40,614
5 persons 30,253 34,624 38,626 39,112 46,247
6 persons 33,552 38,399 42,837 43,376 51,289
7 or more persons 36,850 42,173 47,047 17,640 56,331


  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 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.
  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 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 April 30th, 2021, and the link will deactivate on May 1, 2021.

The application must be completed in full, with all supporting documents uploaded, before it will be considered. Any applications still incomplete after April 30th, 2021 will NOT be considered.


Share |
© 2021 Smiles 4 Canada