GAS Registration Form

As a 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™ programme.

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

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, however free of charge.

I understand that I am expected to start one GAS patient each year and they can be from the dental health waiting list or self screened. If I wish to start more or less than one patient a year from the public waiting list I will contact my state liaison officer to organise.

Please note: If you would like any clarification on your responsibilities, patient allocation and frequency as a Give a Smile™ Orthodontist please do not hesitate to contact your State liaison officer or Give a Smile™ directly (on 1300 661 613 or email [email protected]) prior to completing this registration form. 

Provide the address of the practice/s where you are happy to treat Give a Smile™ patients

Enter your best daytime contact number or numbers

Enter your email address