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Consent for Fluoride Varnish

What is fluoride varnish

Evidence shows that fluoride varnish makes the teeth harder and that helps to prevent cavities. It may even reverse the start of early cavities. The fluoride varnish application can be done at your child’s school at no cost to you.

Why fluoride varnish is important

You may not be aware that the municipal water supplies in the KFL&A region do not contain fluoride. Most children would benefit from a fluoride varnish application two times a year, and a child at higher risk of developing cavities would benefit from a fluoride varnish application at least two to four times a year.

Keep up regular visits with your family dentist

Keep up regular visits with your family dentist. Fluoride varnish application does not replace your child’s regular visits with their dentist. To maintain the best possible dental health for your child, please keep your regular appointments with their dentist. If you do not have dental coverage for your child, you may be eligible for the Healthy Smiles Ontario program. For more information, call KFL&A Public Health at 613-549-1232, ext. 1218 or visit kflaph.ca/HSO.


 

Important note to parents and caregivers

A paper of this form was sent home with your child. If you have already returned the paper copy, please do not complete this online form. If you would prefer to fill out a paper copy, but you have misplaced it, print this form to fill out and return to school, daycare or community group with your child. 

If you have more than one child who is eligible for fluoride varnish, complete a consent form for each child.

For information call KFL&A Public Health at 613-549-1232, ext. 1218.


Diagnosis of asthma that requires an inhaler

If your child has asthma, they will not receive fluoride varnish at school, daycare, or community site.

PLEASE DO NOT COMPLETE THIS ONLINE FORM. Instead, talk to your dental provider about fluoride varnish. If you don’t have a dentist, call KFL&A Public Health community dental hygiene clinic at 613-549-1232, ext 1218.


Collection of personal health information

Personal health information collected on this form is kept confidential and used to monitor local data, plan and provide local programs and services, case management, program administration, and program evaluation. You may withdraw your consent to provide additional health information at any time. Any questions about the collection and use of this information should be directed to the manager of dental health, KFL&A Public Health, 221 Portsmouth Ave., Kingston, Ontario or call 613-549-1232, ext. 1141.


 

Does your child have a diagnosis of asthma that requires the use of an inhaler?
 


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