Smith's first screen role was a small part in the film "Escalation" (1968) following this with a role in "The Mini-Affair" (1967), although the latter was released first. Smith first worked for Hammer Film Productions in "Taste the Blood of Dracula" (1969), billed as 'Maddy Smith' and playing an East End prostitute. Among her other film appearances, she played opposite Ava Gardner in "Tam-Lin", Peter Cushing in "The Vampire Lovers" and "Frankenstein and the Monster from Hell", Diana Dors in "The Amazing Mr Blunden", Frankie Howerd in "Up Pompeii" and "Up the Front", and Vincent Price in "Theatre of Blood". In 1972, Smith appeared in "Carry On Matron" in a scene alongside Hattie Jacques, Barbara Windsor and Joan Sims. In 1973, she played the Bond girl Miss Caruso, in the post-opening titles sequence of "Live and Let Die", the first James Bond film starring Roger Moore. Smith's role is therefore significant as Miss Caruso is the first Bond girl of the Roger Moore era. She was recommended for the role by Moore himself, having previously appeared with him in an episode of "The Persuaders!" on TV.