Healthy Smiles Ontario Parent Notification Form

The Healthy Smiles Ontario Parent Notification Form Emergency and Essential Services Stream was recently updated.

Healthy Smiles Ontario is a government-funded dental program that provides free dental services for eligible children 17 years or younger. The program is designed for lower–income families in need of support.

Your child received the Healthy Smiles Ontario Parent Notification Form for the Emergency and Essential Services Stream to let you know your child has a dental condition that needs immediate dental treatment by a dental provider.

What to do with the form

Complete either Section 1 or Section 2.

Section 1: Child is already enrolled in Healthy Smiles Ontario or can pay for treatment.

• Complete Section 1.
• Take the Emergency and Essential Services Stream Form to your dentist.
• Ask your dentist to complete and sign Section 1 on the form.
• Mail the completed, signed form to the Peel Public Health address printed on the form within 20 business days.

Section 2: Your household would suffer financial hardship if you had to pay for treatment.

Complete Section 2A.

If you answered NO to BOTH questions in Section 2A, you do not meet the financial eligibility requirements for the Emergency and Essential Services Stream of the Healthy Smiles Ontario program. Complete Section 1 of the form.

Learn about the Ontario Child Benefit.

If you answered YES to either question in Section 2A, you meet the financial eligibility requirements for the Emergency and Essential Services Stream of the Healthy Smiles Ontario program. Complete all of Section 2.

• Ensure you sign Section 2E.
• Mail the completed, signed form to the Peel Public Health address printed on the form within 20 business days.
• Once the child’s enrolment is confirmed, you will receive a welcome package and a Healthy Smiles Ontario dental card in the mail.
• It’s important to wait for the child’s enrolment in the program to be confirmed and wait to receive the Healthy Smiles Ontario dental card before obtaining dental services.
• The Healthy Smiles Ontario dental card must be presented to a dental provider at each visit to receive dental care under the program.
• Any dental services received before confirmation of program enrolment will not be reimbursed.

Finding a participating dentist after program enrolment is confirmed

• If you have a dental provider, contact them to find out if they participate in the Healthy Smiles Ontario program.
• If you do not have a dental provider or your dental provider does not participate in the Healthy Smiles Ontario program, ask family or friends to recommend a dental provider.
• If you still cannot find a dental provider, contact Peel Public Health at 905–799–7700.