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Dental Program Forms

Purple "Healthy Smiles Ontario – Parent Notification - Preventive Services Only Stream" Form


What is the Healthy Smiles Ontario – Parent Notification – Preventive Services Only Stream Form?

Peel Public Health dental hygienists visit Peel elementary schools to provide dental screenings. A dental screening is a visual check of a child's mouth and teeth.

During a dental screening an oral health professional found that your child would benefit from preventive dental services. Healthy Smiles Ontario provides FREE services through the Preventive Services Only Stream. 

Preventive dental services may include:

  • Dental Cleaning - a thorough cleaning of the teeth that cannot be
    achieved at home
  • Pit and Fissure Sealants - a plastic material that is placed on the chewing
    surface of the molars to prevent cavities
  • Professionally Applied Topical Fluoride - a gel applied to the teeth to prevent cavities

Why did my child get this type of form?

Your child received this form to inform you that your child may benefit from preventive dental services.

This form is given only to children who have had a dental screening at an elementary school.

What should I do with this form?

Please DO NOT take this form to a dentist.

Call Peel Public Health at 905-799-7700 to see if your child qualifies to receive these services free of charge.

If your child does qualify, then you can make an appointment for your child at a Peel Public Health Preventive Dental Clinic. Be sure to bring the purple form to the appointment.

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Revised: March 24, 2020

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