Share Your Story

Your journey can inspire others who are considering dental treatment through the Smile Restoration Fund.

Personal Information

Tell us about yourself and your experience with the Smile Restoration Fund.

First Name*

Last Name*

Email Address*

Phone Number (Optional)

City*

State*

Your Dental Story

Tell us about your experience with the Smile Restoration Fund and how it has impacted your life.

What procedure did you receive funding for?*

Your Story*

Please include details about your dental issues before treatment, your experience with the fund and dental provider, and how your new smile has affected your life.

Before Photo (Optional)

Click to upload before photo

PNG, JPG, GIF up to 5MB

After Photo (Optional)

Click to upload after photo

PNG, JPG, GIF up to 5MB

I give permission for the Smile Restoration Fund to share my story and photos on their website, social media, and other promotional materials.*

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