Earl B. and Loraine H. Miller 
Orthodontic Pavilion

Prospective patients, ages 6-16, are welcome to apply to the program and must live in Long Beach, Lakewood, or Signal Hill, or attend school in Long Beach.  Applicant screening will take place by appointment.  Children with qualifying orthodontic needs are accepted from these screenings into the program. At the screening, the applicant will be examined by a doctor and family financials will be reviewed to confirm program eligibility and determine your monthly payment. In addition to a monthly payment, there will be a one-time start-up fee of $120 which covers x-rays and patient models.


The easiest way to submit this information is by completing this Online Form. After completing it, click Submit button.

However, if you prefer to mail or fax the information to us, click to download the printable PDF form, fill it in, then mail or fax it to us at the address or fax number below.

If you have any questions, you can contact us at (562) 425-9453 or send an email message to us.

Mailing Address

Assistance League of Long Beach
Attn:  Earl B. and Loraine H. Miller Orthodontic Pavilion
6220 East Spring Street
Long Beach, CA 90815

Fax Number

(562) 425-9507

Orthodontic Program Application