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Adobe PDF Adobe PDF document  Ontario Seniors Dental Care Program. Change of InformationThe file you are about to download will ONLY work properly if opened with an Adobe Reader 10 or later client. Please do not open this file in a browser.Fill, Print & Save953.0 kb

Form Classification
Classification / Identification:
 Form Number:5128EEdition date: 2019/09 
 Title:Ontario Seniors Dental Care Program. Change of Information
 Ministry:Health  
 Branch/ABC:Health Promotion  
 Program:Health Promotion  
 Purpose of Form:You may use this form if you have applied and are enrolled in the Ontario Seniors Dental Care Program and would like to change the information provided at the time of application. Through this form, you can update applicant information, contact information, marital status and/or spousal information, income declaration, or withdraw consent to disclose personal information and/or personal health information.  

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