Request for Approval of Payment for Proposed Dental Procedures

form completed to obtain approval for dental procedures to be carried out in hospital and covered by OHIP

Need help downloading or filling forms?

Please check our Help page for solutions to common issues.

Alert! Adobe is making changes that affect all PDF forms.

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.

Forms, Links, and Information

Additional Information

Form Number 014-2743-84
Title Request for Approval of Payment for Proposed Dental Procedures
Description form completed to obtain approval for dental procedures to be carried out in hospital and covered by OHIP