Healthy Smiles Ontario Emergency and Essential Services Stream (HSO-EESS) Application Form
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
-
English - 014-5033-64e - Healthy Smiles Ontario Emergency and...PDF
-
French - 014-5033-64f - Healthy Smiles Ontario Emergency and...PDF
Additional Information
Form Number | 014-5033-64 |
---|---|
Title | Healthy Smiles Ontario Emergency and Essential Services Stream (HSO-EESS) Application Form |
Description | This form is to be used by fee-for-service dental providers to enroll clients into the Emergency and Essential Services Stream of Healthy Smiles Ontario. |