Smiles, Inc.
A Smile Makes Everything Better!
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To apply we need the following forms filled out and a copy of your ID and Proof of income for everyone in the household over the age of 18.
You can mail the information to:

Smiles, Inc.
PO Box 248 
South Pittsburg, TN  37380

or Email:

or Fax:


or bring it to Smiles on Tuesdays or Thursdays between 10 am - 4 pm
Please download and fill out application fully.  Be sure to list ALL medications.  Sign every form and initial beside each statement on the Consent for Extractions form.
You only need this form if someone in the household over the age of 18 has NO income.

Have someone who knows that you have no income (not a family member or anyone that lives with you) sign it and have it notarized.
IMPORTANT:  If your information, especially your phone number changes - you have to call and give us your new number!!  Otherwise we have no way of contacting you for an appointment.