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Dental Program Forms

Healthy Smiles Ontario (HSO) Program Enrolment Form

Healthy Smiles Ontario is a government-funded dental program that provides free preventive, routine, and emergency dental services for children and youth 17 years old and under from low-income households.

The program includes regular visits to a licensed dental provider and covers the costs of treatment including:

  • check-ups
  • cleaning
  • fillings
  • x-rays
  • scaling 
  • urgent or emergency dental care

Cosmetic dentistry, including teeth whitening and braces, are not covered by the program.

Who is eligible

Your household is automatically enrolled in the program if you or your child receives benefits through:

  • Ontario Works
  • Temporary Care Assistance
  • Ontario Disability Support Program
  • Assistance for Children with Severe Disabilities

Children are eligible for the program if they:

  • Are 17 years of age and under
  • live in Ontario
  • come from a household with an income equal to or less than the levels in the table below

Income eligibility requirements

Number of dependent children in your household

Family net income

1 child

$22,401 or lower

2 child

$24,096 or lower

3 children

$25,791 or lower

4 children

$27,486 or lower

5 children

$29,181 or lower

6 children

$30,876 or lower

7 children

$32,571 or lower

8 children

$34,266 or lower

9 children

$35,961 or lower

10 or more children

$37,656 or lower. Add $1,695 for each additional dependent child to determine the income level at which your family would qualify for Healthy Smiles Ontario.

Coverage period

Once your child is enrolled, they are covered:

  • up to one benefit year (August 1st of the current year to July 31st of the following year), or
  • up to their 18th birthday. If your child turns 18 during the benefit year, they're no longer eligible.

If your child is in the program for emergency or essential care, they are covered for 12 months from the date of enrolment. Clients receiving emergency or essential care must re-enrol after 12 months.

How to enrol

You can enrol in the program online or by mail.

Once your child's enrolment is confirmed, you will get a Healthy Smiles Ontario dental card in the mail. You must present your card to your dental provider at each visit to receive services under the program.

You can enrol online at ontario.ca/healthysmiles

Or Apply by mail

  • download, print and complete the application form
  • mail the completed form to:
    Healthy Smiles Ontario
    33 King Street West
    PO Box 645
    Oshawa, ON
    L1H  8X1

You can also get an application form from Peel Public Health at these locations or at a ServiceOntario location.

 

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