Give Back a Smile Volunteer Laboratory Sign-up

The American Academy of Cosmetic Dentistry Charitable Foundation's Give Back a Smile (GBAS) program provides dental care at no cost to survivors of intimate partner violence who have received traumatic dental injuries to the smile-zone at the hands of a former intimate partner or spouse. Through this program, volunteer laboratories provide the necessary laboratory work crucial to restoring smiles.

We urge you to join us in what may be the most important program you will participate in during your dental career. Your participation is vital to its success and can be a gratifying experience as you share your resources and talents with a survivor in need.

For complete volunteer guideline information, please click here. 

Units per year            *  AND/OR
Full cases per year regardless of units
Check this box if dentures are NOT available
Check this box if implants are NOT available
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Fax:
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By checking this box, the undersigned represents and warrants that he or she has (i) and all  licenses, permits or other authorizations necessary to perform services to patients of the program, (ii) has and will maintain professional liability insurance in amounts customary in his or her geographic area and covering the work to be performed for patients in the program, (iii) has the education, training and experience necessary to perform services and (iv) will follow program guidelines.
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