GKAS Forms

Give Kids a Smile Day Forms and Helpful Downloads

Thank you for your participation in Give Kids a Smile Day!
Dentists and dental staff all over Colorado, and nationwide, support this ADA and CDA effort to give free dental services to low-income children. The Colorado Dental Association has prepared several forms and information pieces for this event for reporting and to assist you in your volunteer efforts. 

Patient Treatment Information:

Patient Appointment Reminder Letter.  If you are providing treatment in your office for Give Kids a Smile Day, we strongly encourage you to remind your patients of their appointments. Programs of this nature typically produce a higher than normal number of “no show” patients. This letter has been produced to provide your office with a tool to help minimize “no shows.” You are welcome to modify it for your office’s use.

Give Kids a Smile Day Consent Forms in English and Spanish. You are welcome to use your own patient consent and health history forms. If you would prefer not to, the above consent form and this health history form is available for your use.

Additional Treatment Information: 

Follow-up Care Forms: Dental Lifeline Network (formerly the Colorado Foundation of Dentistry for the Handicapped) Donated Dental Services Program will provide Follow-up Care for GKAS patients who need additional, immediate treatment. Simply make copies of their follow-up care form, fill out the appropriate information and mail/fax the forms to the Donated Dental Services Program. Your patient(s) will be contacted by the program and will be scheduled for additional treatment. Please also be sure to use the Patient Notification Flyer.  Make copies and give this flyer to each family who you refer for additional treatment – this is a measure to assist with communication between Dental Lifeline Network and the patient.  On Give Kids a Smile Day, you are going to meet some needy families and some great kids. There will also be some great needs that really touch your heart. You’ll wish there was something more you could do.

Kids in Need of Dentistry (KIND) Information Sheet: Please make copies of this English/Spanish, two-sided flyer and give it to ALL of your GKAS patients, regardless of whether or not they need additional care. This is a resource to help them later, should they need dental care in the future.

School Presentation Information and Education Materials:

 A selection of activity sheets are included for you to reproduce and keep in your waiting room or take to schools for presentations.



We hope your Give Kids a Smile Day event was a success, and we would love to hear your feedback and comments. Please feel free to call Molly Pereira at the CDA if you have ANY questions regarding the event or this packet, 303-996.2844.

Thank you again for your participation in this national access day, we greatly appreciate your dedication and generosity!