A Smile Makes Everything Better!
To apply for our services you need to download the form below, fill all forms out, gather proof of income for everyone in the household over the age of 18, copy your photo ID and insurance card (if you have one) and bring or send your completed application to Smiles.
You will be put on the list for dental services after we receive a completed application with ALL supporting documentation. You will be called for an appointment.
There is a waiting list.
INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
You can mail the information to:
PO Box 248
South Pittsburg, TN 37380
or bring it to Smiles on Tuesdays or Thursdays between 10 am - 4 pm
We are located in the old National Guard Armory behind the Church of God and Moss Motors in South Pittsburg.
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.
Click here to open application
Attention Jackson County, Alabama residents:
All Jackson County residents must apply through the Community Action Center. To schedule an appointment to apply call Norma Harvey. She is in Scottsboro Mondays, Tuesdays and the first half of Wednesday. The phone number for Scottsboro is 256-259-5357. She is in Stevenson the 2nd half of Wednesday, and all day Thursday and Friday. The Stevenson phone number is 256-437-2210. The application and requirements to apply are the same as if you come directly to Smiles.