Application form to become a Give a Smile™ Orthodontist

Give a Smile™  ABN: 80 073 394 969

www.giveasmile.org.au

 

Application form to become a Give a Smile™ Orthodontist

 

Being a Full Member of the Australian Society of Orthodontists (ASO), I would like to commit support to and active involvement in the ASO’s Give a Smile™ program.

I have read the Give a Smile™ Charter and agree to be bound by the terms and conditions outlined in that document.

I agree to accept one patient per year from the public dental health waiting list and to diagnose and undertake the necessary orthodontic treatment for that patient in my practice free of charge.

Additionally, I agree to treat my Give a Smile™ patient/s with the same high levels of care and professionalism that I offer to my full fee-paying patients.

NB: At your discretion you may charge for additional costs such as the replacement of lost or broken retainers.

 

Complete the application form below and Submit to register your interest in becoming a Give a Smile™ orthodontist.

A member of the ASO Secretariat will contact you to confirm your interest and verify your details.