Application for Assistance
COTTS want to “help heal your smile”.
As Children Of Tetracycline Teeth Staining (COTTS) continues to grow, we wish to help as many sufferers as possible. We can’t do this without the help of our generous donors. Any amount donated to COTTS will go towards the fight to help the victims [finally] smile.
Below you will find an application for assistance. If you are a tetracycline teeth staining sufferer, please fill out the form in its entirety, following all directions. Submit your completed application and photos of your tetracycline smile to firstname.lastname@example.org to see if you qualify.
Click on the image to download the application.
Disclaimer: Filling of the application does not in anyway guarantee assistance. COTTS and all affiliates do not assume responsibility for any applicant unless otherwise stated in writing.