Application and Eligibility Process

If you live in Tennessee, Georgia or Alabama, please click on the application to download and fill out.

We MUST have proof of all income for every adult in the household over the age of 18, a copy of the patient’s photo ID and a copy of the patients medical insurance.

If you do not have a job or other way to prove income, please fill out the Declaration of Household Income form included with the application.

** Important Note **

If your phone number changes, you MUST call and give us your updated number. If you do not give us your new number we will not be able to reach you.

In person applications accepted on Tuesdays and Thursdays between 10 a.m. and 4 p.m.

SMILES is located at:

107 East 10th Street

South Pittsburg, TN 37380

(Inside the old National Guard Armory)

MAIL APPLICATION TO:

SMILES, Inc.

P.O. Box 248

South Pittsburg, TN 37389

(You will be contacted to confirm your place on the waiting list.)