|Classification / Identification:|
| ||Form Number:||014-4953-64E||Edition date: ||2020/04 |
| ||Title:||Healthy Smiles Ontario - General Application|
| ||Ministry:||Health and Long-Term Care|| || |
| ||Branch/ABC:||Public Health|| || |
| ||Program:||Public Health|| || |
| ||Purpose of Form:||Healthy Smiles Ontario General Application form for the core services stream of the program. This form applies to applicants that have a valid SIN and have filed a statement of income or a tax return with the CRA.|| || |
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