Dental Screening Parent Notification Form
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This page contains information for parents and guardians whose children received a notice home from Region of Waterloo Public Health after participating in an in-school Public Health Dental Screening.
You received the notice because your child has an urgent dental problem and needs dental care right away. Your child may qualify for free dental care.
The notice includes a form and a prepaid envelope that must be returned to Region of Waterloo Public Health.
Once the completed form is received by Public Health, your child will be removed from our follow-up list.
Please proceed with one of the following options that best applies to you:
| Option 1: I am able to pay for my child's dental care. |
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If you can pay for your child's dental care out of pocket or using health insurance, please book them an appointment with a dentist as soon as possible. Take the form with you and your dentist will complete section 1. This is the only section of the form you need filled out. Send the completed form to Public Health using the prepaid envelope that came with the form. (You do not need a stamp.) |
| Option 2: My child is already enrolled in Healthy Smiles Ontario. |
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If your child is already enrolled in Healthy Smiles Ontario (HSO), please book them an appointment with a dentist that accepts HSO patients and bring your HSO card to the appointment. Take the form with you and your dentist will complete section 1. This is the only section of the form you need filled out. Send the completed form to Public Health using the prepaid envelope that came with the form. (You do not need a stamp.) |
| Option 3: I am unable to pay for my child's dental care. |
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If you are unable to pay for your child's dental care, you have the option to enroll them in the Healthy Smiles Ontario program.
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