To apply for financial assistance from Gabriella’s Smile, please complete the following application. Upon submission we will send a request to your health care provider for additional required information. Once complete, your healthcare provider must submit the application via email or fax. Submission of an application is not a guarantee of receiving a grant. Funds are limited and based on the availability. Once your application is approved, we will notify you via email.
Alternatively, download the application and deliver manually to your medical provider by clicking here. Once complete, your healthcare provider must submit the application via email or fax.