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Dental Program Forms

As of January 1, 2016, HSO and CINOT will be changing into a new integrated program for children. This change will provide seamless enrolment and make it easier for children and youth to get free dental care.

Healthy Smiles Ontario (HSO) Program Enrolment Form and Memo

Sample   Sample

What is the Healthy Smiles Ontario (HSO) Program Enrolment Form?

  • The Healthy Smiles Ontario (HSO) Program Enrolment Form is for families wishing to enrol their children in the Healthy Smiles Ontario (HSO) Program.
  • The Healthy Smiles Program aims to improve the oral health of children and youth by providing access to preventive dental care for children from low income
    families and therefore reducing the need for urgent
    dental treatment.

How will I get this form and what should I do with this form?

  • Pick up and drop off your Healthy Smiles Ontario
    Enrolment Form at any of these locations.
  • You can also download the Enrolment Form online.
Enrolment Form Checklist
Before dropping off your form:
  • Did you sign all three sections of the form: Section A, Section C and Section D?
  • Did both parents (if parents are married/common-law) sign all three sections of the form: Section A, Section C and Section D?
  • Do you have all the required documents that you need to present?
Unfortunately, we are unable to process incomplete forms. If forms are incomplete, it will delay processing.

What documents do I have to bring with me when I drop off my form?

  • You will need to enrol in person at one of the Region
    of Peel locations indicated and show the following documents:
    • Annual Canada Child Tax Benefit and Ontario Child Benefit Notice OR Annual GST Credit Entitlement Notice (most recent tax year)
    • Government issued identification (one of the following:
      • Ontario Health Card
      • Passport
      • Canadian Citizenship Card
      • Permanent Residence Card
      • Canadian Immigration Identification
      • Ontario Drivers Licence)
    • Child’s Ontario Health Card

What if I do not have all of the documents?

  • If you do not have all the required documents
    you may still be able to apply to the program,
    call Peel Public Health at 905-799-7700 or visit
    one of these locations.

Where can families access dental care as part of Healthy Smiles Ontario?

  • Once a child qualifies for the Healthy Smiles Program, Peel Public Health will advise the family of the dental service options available.
  • The client card is valid for up to one year, or up to the child’s 18th birthday, whichever is earlier.

My Healthy Smiles client card is almost expired what should I do?

  • At least one month prior to the expiry date of your card, Peel Public Health will contact you via mail to provide the documents required for renewal or application.

What should I do if I lose my Healthy Smiles client card?

  • Call Peel Public Health at 905-799-7700 as soon as
    you realize the card is lost and we can arrange for a
    replacement card.

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Revised: August 10, 2015


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