English - 014-5036-64e - Healthy Smiles...
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.
Additional Information
| Last updated | November 7, 2022 |
|---|---|
| Created | December 11, 2021 |
| Format | application/pdf |
| Form Number | https://forms.mgcs.gov.on.ca/dataset/52613fbb-9095-4b4c-9468-8e30c233d2c2/resource/d2f94fb8-c801-4d9c-ac55-a49c9917b3ed/download/5036-64e.pdf |
| Form File Identifier | |
| Name | English - 014-5036-64e - Healthy Smiles Ontario - Ontario Works First Nations Verification Form |
| Form File Status | Available |
| 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. |
| Language | English |
| Functionality | Fill, Print, and Save |
| Form File Content Type | Form |
| Remark | Form update with references to Queen’s Printer to reflect the change in sovereign to King’s Printer |
| Edition Date | 2022-11 |