Apply for a New Smile

General Requirements

After you complete this form, we will review and contact you as soon as possible.

Eligibility

To determine if a prospective patient is a good candidate for free dental implants, we will need some important information from you.

Financial Qualification

To qualify for free dental implants, you should be able to show that you cannot afford the cost of the procedure.

Documentation Required

If you are a good prospect for a new smile, we will ask you to bring certain documentation to your initial consultation:

• Proof of Income
• Tax Returns
• Other Financial Documentation

New Smile Foundation Headquarters

We're located in north Dallas, near highways 635 and 75.

11970 N Central Expy #430, Dallas, TX 75243

Application Form

First Name *

Last Name *

Email Address *

Phone Number *

Address

City

State

Zip Code

Are you a military veteran?

Tell us about your situation *

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