Government of Ontario
Ontario Seniors Dental Care Program
Print Blank Application Form
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Government of Ontario
Ministry of Health
Ontario Seniors Dental Care Program
Station P, P.O. Box 159
Toronto, ON M5S 2S7

Ontario Seniors Dental Care Program

Application Instructions

The Ontario Seniors Dental Care Program (“the Program”) provides comprehensive dental care to eligible low-income seniors. The benefit year for the program is August 1st to July 31st. A Senior is eligible for the Program if they:
  • Are 65 years of age or older;
  • Are a Resident of Ontario;
  • Are a Single senior with annual net income (i.e. total income after paying taxes and other deductions) of $25,000 or less, or senior couples (one or both people aged 65 or older), with a combined annual net income of $41,500 or less; and
  • Have no other form of dental benefits, apart from the Canadian Dental Care Plan (CDCP), including private insurance or dental coverage under another government program such as Ontario Works, Ontario Disability Support Program or Non-Insured Health Benefits. Clients may qualify for the CDCP and may still be eligible for the OSDCP provided the client meets the eligibility criteria.
As a senior, you may use this application form to apply for the Program if you and your spouse (if applicable) have filed your Personal Tax Return(s) with Canada Revenue Agency (CRA) for the most recent tax year and have a valid Social Insurance Number (SIN). 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.
Alternatively, if you or your spouse, if applicable, do not have a SIN and/or have not filed your tax return(s), you will need a Guarantor to confirm you meet the eligibility requirements of the Program. If this applies to you, please complete the Ontario Seniors Dental Care Program Application through Guarantor Form (5126E).

To apply to the Program:
  • You will need your Social Insurance Number (SIN), and if applicable, your spouse’s SIN. If you do not have a SIN, you will need a Guarantor to confirm you meet the eligibility requirements of the Program. If this applies to you, please complete the Ontario Seniors Dental Care Program Application through the Guarantor Form (5126E).
  • Complete and sign all sections of this Application Form that apply to your situation. Please note, this form requires the applicant’s signature in two sections (Section 4 and 6).
  • If you are married or have a partner, they also need to share their information on this form and give their agreement, no matter how old they are. This information is required to properly assess your annual net income eligibility for the Program.
  • If you and your spouse or common-law partner are applying to the program, you must submit two separate applications

There are two ways to apply to the program:
  1. Apply Online

    To apply to the Program online, review the list below and select all the checkboxes to confirm that you have everything needed before you start the online application. You will have two (2) hours to finish your online application before the session automatically ends.

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  2. Apply by Mail

    To apply to the Program by mail, please print and fill out the blank application form and mail your completed application form to:

    1. Ministry of Health
      Ontario Seniors Dental Care Program
      Station P, P.O. Box 159
      Toronto, ON M5S 2S7

    To have an application form mailed to your address, please contact your local public health unit.

After You Apply
  • Regardless of whether you apply by mail or online, the Program Administrator will contact you or your legal representative (including a substitute decision maker, power of attorney for personal care, or a court-appointed guardian of the person) if there are any issues with the application. You will be notified of the status of your application by letter once it has been reviewed.
  • If your application is approved, you will receive a welcome package and dental card in the mail with an expiration date of July 31 of the current benefit year (the Program operates using a Benefit Year (BY) from August 1 to July 31).
  • Your eligibility will be automatically assessed before each benefit year. Annual notices will be sent to your mailing address regarding your enrollment status, and if eligible, you will receive a new card for the next benefit year. To avoid delays in the automatic assessment, it is important that you and your spouse (if applicable) file your Personal Tax Return(s) with CRA in a timely manner.
For more information, please visit www.ontario.ca/seniorsdental. If you have additional questions, please contact the Program:
Telephone: 416-916-0204
Toll-free: 1-833-207-4435
TTY toll-free: 1-800-855-0511
Email: ontarioseniorsdental@accerta.ca
Ontario Seniors Dental Care Program Application
Please read the instructions before completing your application for the Ontario Seniors Dental Care Program. Fields marked with an asterisk (*) are mandatory. Complete all required information to avoid processing delays.

Section 1
Applicant Information – Tell Us About Yourself

SIN number already exists in the system. Invalid SIN format. Please enter a valid nine-digit SIN number. The SIN (Social Insurance Number) of the applicant must not match the SIN of the spouse.
Entered applicant date of birth exceeds the maximum allowed date. Invalid date format. Please enter a valid date in the format YYYY/MM/DD. The date of birth entered does not meet program requirements

Residential Address

Mailing Address
Marital Status : *

Section 2
Spouse Information – Tell Us About Your Spouse (if applicable)

If married or in a common law relationship, provide spouse information.

Invalid SIN format. Please enter a valid nine-digit SIN number. The SIN (Social Insurance Number) of the applicant must not match the SIN of the spouse.
Entered spouse date of birth exceeds the maximum allowed date. Invalid date format. Please enter a valid date in the format YYYY/MM/DD. The date of birth entered does not meet program requirements

Section 3
Terms and Conditions of the Program

This Application form requires you to agree to the Terms and Conditions below:
I declare that:
  • I meet the following eligibility requirements for the Ontario Seniors Dental Care Program:
    • 65 years of age or older;
    • Resident of Ontario;
    • Single senior with annual net income (i.e. total income after paying taxes and other deductions) of $25,000 or less, or senior couple (one or both people aged 65 or older), with a combined annual net income of $41,500 or less; and
    • Have no other form of dental benefits, apart from the Canadian Dental Care Plan (CDCP), including private insurance or dental coverage under another government program such as Ontario Works, Ontario Disability Support Program or Non-Insured Health Benefits. Clients may qualify for the CDCP and may still be eligible for the OSDCP provided the client meets the eligibility criteria.
  • I have not misrepresented information about myself and understand that any misrepresentation may result in immediate removal from the Program, and that the Government of Ontario may seek reimbursement for any services that were rendered while ineligible for the Program.
  • I understand that the information on this Application form may be subject to audit and verification by the Ministry of Health. I must immediately report any changes that may affect my eligibility to the Ministry of Health through the Ontario Seniors Dental Care Program Change of Information Form (5128E). The mailing address given on Section 1 of this Application form will be the address used for correspondence.
  • I understand that only certain dental procedures are covered under the Program, as listed in the Ontario Seniors Dental Care Program Schedules of Dental Services and Fees. I am responsible for paying for services not covered or paid for under the Program, and for any services rendered after the end date of my eligibility period.
  • I understand that the dental card is valid for up to one benefit year (August 1 – July 31) from the registration date and will expire at the end of each benefit year (July 31). I understand that the Ministry of Health will re-confirm that I continue to meet the eligibility requirements of the Program following the Program eligibility period end-date each benefit year (July 31).
  • I understand that the Ministry of Health will keep my application information on record for the purpose of annual eligibility verification. I understand that I must re-apply to the Program if I did not file taxes for the most recent tax year(s) on which eligibility is being verified and/or determined.
  • I understand that I must present the dental card to the dental provider at each visit in order to obtain services under the Program. Dental providers will not render services under the Program unless a valid dental card is presented.
Notice of Collection: The information collected in this form will be used by the Ministry of Health for the purpose of determining eligibility under the Ontario Seniors Dental Care Program (the “Program”) and otherwise administering the Program. The Ministry of Finance collects the personal information described in this form for the purpose of assisting the Ministry of Health in determining eligibility under the Ontario Seniors Dental Care Program (the “Program”). The Ministry of Finance’s authority to collect and disclose personal information with the Ministry of Health is in section 11 of the Ministry of Revenue Act.

If you have questions about the collection of information in this form, please contact:

Ontario Seniors Dental Care Program
Ministry of Health
P.O. Box 12
Toronto, ON M7A 1N3
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    Existing Application

    Our record indicates that you have previously applied to the Ontario Seniors Dental Care Program. Please contact us at 1-833-207-4435 to re-apply. If you wish to make changes to a previously submitted application, please contact the Program: 416-916-0204 Toll-free: 1-833-207-4435 TTY toll-free: 1-800-855-0511. If you have been approved for our current benefit year, your application will be sent for renewal automatically and you will receive a letter regarding the renewal outcome.