Additional Information

Last updated November 7, 2022
Created December 11, 2021
Format application/pdf
Form Number
Form File Identifier
Name French - 014-5036-64f - Healthy Smiles Ontario - Ontario Works First Nations Verification Form
Form File Status Available

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 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