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To participate in Give Back, Smile Back, please fill out the form below. 

Required Event Information:

Please enter details about the charity and how many patients your Practice will be treating below. You will need to connect with the charity prior to filling out this form.

NOTE: If you would like dentalcorp to pick the charity, please indicate in the section below. Our chosen charity for 2018 is United Way.

Required Team Information:

Please enter the number of t-shirts you will need of each size below. Every member of your team that is participating will receive a t-shirt. Please type zero if you don't require any of a particular size.

Media Opportunities

Give Back, Smile Back is a great opportunity for community exposure. dentalcorp will assist for media pitches and PR opportunities.

If you have any further questions about the Give Back, Smile Back program, please feel free to reach out to a member of the Charity Committee by emailing