If you have a patient or loved one with an intellectual or developmental disability who could be served by the dental services that A Gift Of Smiles foundation provides, please fill out our referral document below. Our treatment coordinator will contact you when the application has been reviewed. We do not receive phone calls to update the status of applications.

Eligibility

Acceptance as a foundation patient is dependent upon meeting certain criteria including but not limited to:

  • Adult or child must reside in the central Pennsylvania area (Cumberland, Dauphin, Perry, York Counties).
  • The patient has a developmental and/or intellectual disability.
  • While priority funding is given to those patients with limited financial resources who do not have private dental insurance, all applications are reviewed on a case by case basis.
  • Completion and submission of patient referral form.