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Smile Time Application - 2026 GIVEAWAY

For several years, Advanced Oral Surgery & Dental Implant Studio has proudly performed life-changing surgery to individuals in need of better oral health. We encourage all members in our community who are missing or failing teeth to apply for our It’s Time to Smile program.

We will choose one recipient to undergo a full-arch restoration, a transformative procedure that provides a fully functioning, healthy, and natural-looking smile.

Applications are open from December 8th through December 19th.

The selected recipient will be announced in early 2026.

Age

Occupation

Employer

Are you active duty or veteran?

Phone number

Dentist - If you do not have one, list none

How did you hear about our Smile Time Program?

Tell us about your dental health:

Why is restoring your smile important to you?

Tell us about an obstacle in your life that you had to overcome or plan to overcome in the future. This does not need to be smile-related. We just want to get to know you better.

Why are you a good candidate for our Smile Time Program?

How many teeth are you missing, if any?

0-5

6-10

11-15

16-20

21-25

25+

How many of your remaining teeth are damaged?

0-5

6-10

11-15

16-20

21-25

25+

Please describe where your missing or damaged teeth are in your mouth.

Will you be available to attend regular appointments at our practice?

Yes

Have you ever taken medication for osteoporosis?

Yes

Have you ever had any radiation to the head, neck, or face?

Yes

Do you have any bleeding disorders or take any blood thinners?

Yes

Are you currently pregnant or planning to become pregnant in the next 12 months?

Yes

Are you currently a smoker?

Yes

Have you smoked regularly in the past?

Yes

Are you an insulin-dependent diabetic?

Yes

Do you now or have you had problems with substance abuse?

Yes

Please list all medications you are taking:

Have you ever been convicted of a crime and/or is there a pending litigation against you or someone in your household?

Yes

Please indicate your household income:

$0-20,000

$20,000-40,000

$40,000-60,000

$60,000-80,000

$80,000+

Please make sure to click the UPLOAD button after you have selected your photo.

Upload one clear photo of your smile. Upload File(s) up to 250mb. Please see the example below.

Click Here to Upload

Upload one clear photo showing your missing or damaged teeth. Upload File(s) up to 250mb. Please see the example below.

Click Here to Upload

Media Release Acknowledgment

I give Advanced Oral Surgery permission to use my name, story, certain high-level information about my health history, and all photos/videos taken by us before, during and after my treatment (collectively, my "Information") for marketing or educational purposes in websites and social media platforms, press releases, marketing or educational materials, and news or media features (collectively, the "Materials"). I can revoke my consent to use my name, story, high level health information, or photos by emailing Katie Hawkins Katie.Hawkins@oralsurgerymi.com. I understand that my treatment and payment is not conditioned on signing this authorization. I further understand revocation will not affect information already used or disclosed in reliance on this authorization, and once my information is disclosed pursuant to this authorization, it may no longer be protected by HIPAA and disclosed by third parties.

I have read and agree to the Terms and Conditions of the Smile Time Program (listed below)

Yes

Click here to view the Official Terms & Conditions

Full Address

Smile Time Application - 2026 GIVEAWAY

Full Date

Full Name

Home Address

How many teeth are you missing, if any?

How many of your remaining teeth are damaged?

Will you be available to attend regular appointments at our practice?

Have you ever taken medication for osteoporosis?

Have you ever had any radiation to the head, neck, or face?

Do you have any bleeding disorders or take any blood thinners?

Are you currently pregnant or planning to become pregnant in the next 12 months?

Are you currently a smoker?

Have you smoked regularly in the past?

Are you an insulin-dependent diabetic?

Do you now or have you had problems with substance abuse?

Have you ever been convicted of a crime and/or is there a pending litigation against you or someone in your household?

Please indicate your household income:

Please make sure to click the UPLOAD button after you have selected your photo.

Upload one clear photo of your smile. Upload File(s) up to 250mb. Please see the example below.

Upload one clear photo showing your missing or damaged teeth. Upload File(s) up to 250mb. Please see the example below.

Media Release Acknowledgment

I have read and agree to the Terms and Conditions of the Smile Time Program (listed below)