Chat with us, powered by LiveChat PHS Application - Georgia School of Orthodontics
Please fill out all information below.
Active or Retired Military?
ActiveRetired
Do you have orthodontic dental insurance?
YesNo
Documentation Needed (attach or enclose a copy of each with application)

DD214

Purple Heart Certificate

Proof of being either the parent (birth certificate or signed letter of guardianship) or legal guardian of the child

By printing your name below, you are agreeing that all information submitted by you to the Georgia School of Orthodontics is true and complete. We thank you for your service.

Submit completed application electronically by clicking the send button below or you may select print and mail the application to:
Georgia School of Orthodontics, Purple Heart Smiles, 8200 Roberts Drive, Suite 550, Atlanta, GA 30350


Questions? We can help you! Please call us at 770-351-7737 or if you prefer