English - 014-4955-64e - Healthy Smiles...
Paper application required to register via mail. This form is submitted to authorize the MOHLTC (Oshawa) to deal with another person (such as your spouse or common-law partner, other family member, friend, or accountant) as your representative for HSO program matters.
Additional Information
| Last updated | November 8, 2022 |
|---|---|
| Created | December 11, 2021 |
| Format | application/pdf |
| Form Number | https://forms.mgcs.gov.on.ca/dataset/52e71e81-e928-46d3-8753-400bd42afb3a/resource/5cc109c2-5868-4cab-9f15-7ec6863792a5/download/4955-64e.pdf |
| Form File Identifier | |
| Name | English - 014-4955-64e - Healthy Smiles Ontario – Authorizing or Cancelling a Representative |
| Form File Status | Available |
| Description | Paper application required to register via mail. This form is submitted to authorize the MOHLTC (Oshawa) to deal with another person (such as your spouse or common-law partner, other family member, friend, or accountant) as your representative for HSO program matters. |
| 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 |