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Give Kids a Smile Day is an event for school-aged children (3 years - 14 years). Care may include exam/screening, x-ray, cleaning, fluoride and sealants.
Your information will be shared with the Dental Office to make the appointment.
Parent/Guardian Name
*
First
Last
Phone
*
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Appointments are for children age 3 through 14 years old.
Please list the first name, age and birthdate of the child(ren) that would need an appointment at the dentist. Age is important because younger children go faster than teenagers :) THANK YOU
First Name
Age
Birthdate
Child
Child
Child
Child
Child
Appointments are REQUIRED
It is imperative that if you request an appointment that you are able to make it.
Appointments are limited.
*
March 4, 2026 in the afternoon
