Smile Restoration Fund
THE SRF PROGRAM
ELIGIBLE PROCEDURES
SUCCESS STORIES
DENTAL OFFICES
FAQ
APPLY NOW
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The SRF Program
Eligible Procedures
Success Stories
Dental Offices
FAQ
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Apply for the Smile Restoration Fund
Complete the form below to begin your application process.
Personal Information
Please provide your contact details so we can connect you with a participating dentist in your area.
First Name
Last Name
Email Address
Phone Number
City
State
Select state
ZIP Code
Dental Information
Tell us about your dental needs and the procedures you're interested in.
Which procedures are you interested in?
Dental Implants
All-on-Four/Six
Veneers
Dentures
Clear Aligners
Smile Makeover
Do you have a regular dentist?
Yes
No
Please describe your dental concerns and what you hope to achieve:
How did you hear about the Smile Restoration Fund?
Select an option
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Submit Application
