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
I, First Name* Last Name* understand that if my child is selected for a scholarship, I cannot miss scheduled orthodontic appointments. If you cannot make your appointments, please promptly reschedule with the orthodontist. The final payment of $480 is non-refundable if you are removed from the program for noncompliance or no-shows with appointments. Before making our final payment, please make sure you are ready for the commitment that goes along with orthodontic treatment.
First and last name of applicant
Final Payment
prevnext( X )
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