How do I complete the Smiles 4 Canada application?

You can complete the online application. It has 7 parts:

  1. Patient Information Section: This gives us some basic information about you, your child, and your family – primarily how to contact you and any other legal decision-makers in your child's life. You will be asked to provide a copy of your child's birth certificate.
  2. Financial Information Section: Smiles 4 Canada is targeted at lower-income families, specifically those whose total after-tax family income in the previous two taxation years is below the Federal Low Income Cut-Offs (LICO). To substantiate income, we need you to provide information on the income for all your child's parents/guardians and copies of the Canada Revenue Agency's Notice of Assessment, and your Tax Summary/Tax Return (T1 General Form that you submit your taxes to Canada Revenue Agency) for 2019 and 2020. If you are separated or divorced, you will be asked to submit a copy of your separation agreement or divorce decree that outlines the support payments being made from the non-custodial parent. The table below provides information on LICO.
Size of family unit
Rural areas
outside CMA or CA
Census Agglomeration (CA) Census Metropolitan Area (CMA)
Less than 30,000
(small towns)
30,000 to 99,999
(larger towns)
100,000 to 499,999
(small cities)
Over 500,000
(larger cities)
2019 After-tax family income
1 person 18,192 20,696 22,618 22,759 26,426
2 persons 22,647 25,764 28,157 28,332 32,899
3 persons 27,841 31,673 34,615 34,831 40,445
4 persons 33,804 38,457 42,029 42,290 49,106
5 persons 38,339 43,617 47,668 47,963 55,695
6 persons 43,242 49,193 53,762 54,096 62,814
7 or more persons 48,142 54,769 59,856 60,227 69,935
2020 After-tax family income
1 person 18,737 21,316 23,296 23,441 27,219
2 persons 23,326 26,536 29,001 29,182 33,886
3 persons 28,876 32,623 35,653 35,876 41,658
4 persons 34,818 39,610 43,290 43,558 50,579
5 persons 39,489 44,925 49,098 49,402 57,366
6 persons 44,539 50,669 55,375 55,719 64,698
7 or more persons 49,586 56,412 61,651 62,034 72,033


  1. Personal Statement Form: We want your child's treatment to be successful, and an important part of that success is his/her motivation – the more emotional investment your child has in the treatment, the greater the likelihood s/he will work cooperatively with the orthodontist and see it through to completion. In this form, we ask your child to share with us his/her reasons for receiving treatment and goals for the treatment.
  2. Digital Photos Guide: To help us evaluate the severity of your child's dental problems, we ask that you send us 6 specific digital pictures; we need these 6 in order to determine the need and the amount of work to be done. The treating orthodontist will also need this information, plus any x-rays s/he may take, to develop a course of treatment. Each photo must be uploaded separately during the application process.
  3. Personal Reference Form: We ask that you submit a personal reference for your child, to help us understand his/her character. The reference is in the form of a letter, written by someone other than a relative, explaining how the child is affected by his/her teeth and smile, and what his/her character is. The letter is to be submitted with the application.
  4. Program Rules, Expectations and Release Form: This form constitutes an agreement between you, CFAO Smiles 4 Canada, and the treating orthodontist. In it, you agree to ensure your child keeps his/her teeth clean, maintains his/her oral health, complies with the orthodontic treatment (including keeping all appointments, wearing retainers and rubber bands [if necessary]), and has any additional dental work that may be necessary. It also specifies what is included in the treatment, and what you might have to pay for separately. Finally, you are asked to give your consent on a number of important privacy considerations, including the disclosure of financial and health information to the Regional Committee that reviews the application and to the CFAO, and the use of case information that may be used for educational or publishing purposes. Each field must be completed in order for the form to upload.
  5. Dental Examination Form: To undertake your child's treatment, we need to have a good understanding of his/her current and past dental health. To do so, we require your child's general dentist to complete this form and share some basic dental health information with us. Please note: your dentist may charge for the completion of this form. A scan or photo of this form must be uploaded with the application.
  6. Application Checklist: This checklist helps you keep track of the various forms and whether they have been submitted.

To download instructions on completing the application, please click the following link: [English or French]. Once you have all the information, you can complete it here.

Once you have started an application, you may find that you cannot complete it all at one time. You will receive an email with a link to the incomplete application where you may add any missing information. This information must be submitted by 11:59 pm ET on April 30th, 2022, and the link will deactivate on May 1, 2022.

The application must be completed in full, with all supporting documents uploaded, before it will be considered. Any applications still incomplete after April 30th, 2022 will NOT be considered.


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