Additional Information

Last updated November 8, 2022
Created December 11, 2021
Format application/pdf
Form Number
Form File Identifier
Name French - 014-4955-64f - Healthy Smiles Ontario – Authorizing or Cancelling a Representative
Form File Status Available

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 French
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