Program Request Form

Tell us what you need

All fields are required unless marked optional.

1Which program do you need?

Compare programs and eligibility →

2Tell us about the request
0/600
3Where will the program take place?

A school, facility, or home address. We're based in Los Angeles, serve Southern California, and can travel to other parts of California — submit your request and we'll confirm.

Address lookup powered by OpenStreetMap contributors.

4How can we reach you?

We'll follow up within about 24 hours. Nothing is scheduled until we confirm the details with you.

Have a different question? Use our general contact form → or Book a planning call →

What Happens Next

What happens after you submit

No commitment — submitting a request just starts the conversation.

  1. 1 Today

    You submit a request

    Tell us the program, who it's for, and where it would take place.

  2. 2 Typically within 24 hours

    Our team reviews it

    We confirm the program is a good fit and that we can serve your area.

  3. 3 After review

    We follow up to confirm details

    A member of our team reaches out directly to schedule and coordinate next steps.

Common Questions

Before you request

Quick answers to the questions we hear most often.

Who can request a program?

Little Smiles can be requested by school districts, administrators, and parent organizations. Special Smiles can be requested by families, Regional Centers, schools, and residential providers. Senior Smiles can be requested by facility administrators, families, or care staff.

Where do you provide services?

We're based in Los Angeles and serve schools, care facilities, and families across Southern California, with current partners including Silverado, Ivy Park, and Artesia Christian Home. We can also travel to other parts of California — let us know your location and we'll confirm the details.

Is there a cost?

Boundless Smiles is a 501(c)(3) nonprofit, and program costs depend on the scope and size of the request. We'll walk through details after you submit a request. Little Smiles requires no insurance or prior dental visit to get started.

Do I need insurance or a referral?

Little Smiles requires no insurance or prior dental visit. Senior Smiles requires no referral. Special Smiles accepts referrals from families, Regional Centers, schools, and residential providers, but you're also welcome to reach out directly.

What does a visit include?

Visits typically include an oral health assessment, preventive services such as cleanings or fluoride treatments where appropriate, hygiene education, and referral coordination when further care is needed. Specific services vary by program — see our Programs page → for full details.

Still have a question?

Call 310-986-5560 or email info@boundlesssmiles.org.

Not Ready to Request Yet?