Healthy Smiles Ontario - Ontario Works First Nations Verification Form

First Nations clients receiving Ontario Works will fill out this form and mail it to the HSO Program Administrator in order to enroll in the Healthy Smiles Ontario Program.

Need help downloading or filling forms?

Please check our Help page for solutions to common issues.

Alert!

PDF Forms will no longer work with older versions of Adobe Reader including Adobe Reader XI. Please update your free Adobe Reader to the latest version from the Acrobat Reader download page so that you can continue to access these forms.


Download Adobe Reader Free Version

Make the most of your experience with accessing, downloading, and filling forms acquired from the Central Forms Repository by watching this brief video overview.

single frame of the linked video. Click to begin playback in a new browser window
Download English Transcript

Forms, Links, and Information

Additional Information

Form Number 014-5036-64
Title Healthy Smiles Ontario - Ontario Works First Nations Verification Form
Description First Nations clients receiving Ontario Works will fill out this form and mail it to the HSO Program Administrator in order to enroll in the Healthy Smiles Ontario Program.