Nominate a Friend for a Smile Makeover

This program is only available in the Tampa Bay area, Florida and Eastern Kentucky: Nominate a friend, co-worker, employee or family member residing in the Tampa Bay area Florida for Smile Makeover assistance. Individuals in need of dental assistance cannot nominate themselves. Complete the form below and click "Submit". The Nominee will be contacted with instructions on how to proceed. *This is not an urgent dental care program.

**This is not a FREE program. There maybe some financial responsibility on the part of the Nominee.

Nomination Form

To nominate a friend for Smile Makeover assistance, simply complete the form below and click SUBMIT.

Your Info


Person whom you wish to Nominates Info



State why this individual should receive assistance for a smile makeover. Give a detailed, heartfelt explanation: *

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