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014-4637-67
Application for Rehabilitation Assessor/Fitter/Dispenser StatusApplication for Rehabilitation Assessor/Fitter/Dispenser Status014-4658-67
Application for Funding Ocular ProsthesesUsed to apply for Funding for Ocular Prostheses014-5126-20
Ontario Seniors Dental Care Program Application Through GuarantorYou may use this application form to apply for the Ontario Seniors Dental Care Program if you do not have a valid Social Insurance Number (SIN) and/or if you have not filed your Personal Tax Return(s) with Canada Revenue Agency (CRA) for the most recent tax year. If you have a spouse (married or common law partner) who would also like to apply for the Program, they must complete their own application form.on00314
Request for Prior Approval for Full Payment of Insured Out-of-Country (OOC) Health ServicesThis form is meant to be submitted by a practicing Ontario physician on behalf of their patients to request consideration of funding for out-of-country health services. Along with the completed application form, submissions must also include relevant medical documentation.014-4509-67
Application for Equipment Listing Insulin PumpsUse by vendor/manufacturer to apply for equipment listing insulin pumps.014-7026-65
Health Service Organization Information Sheet014-1470-41
Memorandum of Transfer – NCR Patient014-4825-67
Application for Funding Communication AidsUsed to apply for Funding for Communication Aids014-5053-20
Tobacconist RegistrationFor retailers that primarily sell specialty tobacco products to apply for a tobacconist registration.on00325
Application for Emergency Admission to Secure Treatment ProgramEmergency admission of a child to a secure treatment program.014-4956-64
Healthy Smiles Ontario – Change of InformationHealthy Smiles Ontario Change of Information form is a paper form submitted by mail as a result of a change during any benefit year. This form is used to add or change information about the applicant, marital status and/or spouse, and children/youth. This form is only required for those who have applied and been enrolled in the core services stream of the program.
