If you are in need of a helping hand to restore you smile, simply download our application form (click on the red pdf icon), fill this in and email back to us at reviveasmile@gmail.com you can also post your completed form to PO BOX 21053, Hamilton. Please note it may take us time to contact to you as we are often inundated with applications. Our clinic is primarily based in Waikato.

To help our Revive A Smile tooth angels process your application quickly, please provide as much detail as possible and answer all questions.  Feel free to attach photos or any relevant additional information to your application.