Smile for a Lifetime Application FINAL PAYMENT ONLY

Smile for a Lifetime Application FINAL PAYMENT ONLY

Please complete the form below if Smile for a Lifetime has informed you that your application is complete. NOTE: The waiting period for this step of the process varies and can be longer than six (6) months based on the area. If you have any questions while you are waiting to hear about your approval, please contact Smile for a Lifetime and NOT the orthodontist. Thank you!
General Questions
2020 Tax Returns and Financial Information has been submitted:

YesNo, I will do that now before I make final paymentNo, my child is in Foster Care or Out of Home Placement
Dental Clearance Form has been submitted: (Filled out by a dentist)

YesNo, I will do that now before I make final payment
Facial Pictures have been submitted:

YesNo, I will do that now before I make final payment
Letter of Recommendation has been submitted:

YesNo, I will do that now before I make final payment
Report Card has been submitted:

YesNo, I will do that now before I make final payment
Student Essay has been submitted:

YesNo, I will do that now before I make final payment
I, First Name* Last Name* understand if I do not follow through with appointments or am non-compliant, I will not receive the refund of $480. By writing my name I agree to this understanding.
First and last name of applicant
Final Payment
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Final Payment$480.00
Final Payment of $480, will be refunded if we are unable to find an orthodontist

Total $0.00
Should be Empty:

General Questions