NTDS Give Kids a Smile

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Register to provide dental care in your office for uninsured, low-income children, as part of North Texas Dental Society's Give Kids a Smile program. Eligible patients are referred to participating dentists by school nurses for exam, prophy and x-rays. Discounting or providing dental treatment pro bono is at the discretion of the dentist.

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Name/office name, address, phone number:

Name and email address of contact person in your office:

How many GKAS patients are you willing to accept?

1-2

3-4

5-6

I want to participate but have questions. Please call or email me to discuss.

Other:

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I am a...

General dentist

Pediatric dentist

Orthodontist

Oral Surgeon

Endodontist

Periodontist

Other:

Languages spoken in my office:

English

Spanish

Other:

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