IFHP Appointment Request

Dental Appointment Request Form
Thank you for your inquiry about dental coverage under the Interim Federal Health Program (IFHP) and the Canadian Dental Care Plan (CDCP).

Please complete this form, and our team will review your information to help verify your eligibility under the appropriate program.

We will contact you within 2 business days with an update.

If you have any questions, feel free to reach out to us at (416) 553-1464.
Name

First NameLast Name
UCI# / CDCP#
Number of additional family members
Date of Birth

YearMonthDay
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
City

City

Street Address Line 2

CityState / Province

Postal / Zip Code
Which languages do you speak?
How did you hear about us?
Disclaimer

1. No Government Affiliation
We are not affiliated with, endorsed by, or acting on behalf of the Government of Canada or any government program, including the Canadian Dental Care Plan (CDCP). This form is provided solely to help patients access dental care and connect with dental offices that accept their coverage.
2. Optional Disclosure of UCI/CDCP Number
Providing your Unique Client Identifier (UCI) or CDCP member number is entirely optional. This information is requested only to help verify eligibility and facilitate access to dental care services.
3. Consent to Contact (Express Consent)
By submitting this form, you expressly consent to being contacted by us (and, where applicable, by a participating dental office) via phone, email, or text message for the purpose of assisting you in accessing dental care services. We do not send unsolicited marketing communications, and you may withdraw your consent at any time.
4. Use and Sharing of Personal Information
The personal information you provide will be used solely to assess your request and connect you with a dental care provider. Your information may be shared with a participating dental office for this purpose. We handle your information in accordance with applicable privacy laws, including the Personal Information Protection and Electronic Documents Act (PIPEDA).
Should be Empty:

Dental Appointment Request Form

Disclaimer