| ADDRESS: 805 DEVELOPMENT DR, KINGSTON, ON K7M 4W6 TEL: 613-389-8660 EMAIL: reception@davidgouettdentistry.com
# CANADIAN DENTAL CARE PLAN (CDCP) Official Clinical Data Record Submission
The CDCP aims to help support some of the cost of various oral health care services and reduce financial barriers to accessing care for eligible Canadian residents who do not have access to private dental benefits. The CDCP will only pay for oral health services covered within the plan at the established CDCP fees. These fees ARE NOT the same as the provincial oral health association's suggested fee guides that providers use to charge for oral health services. The CDCP will reimburse a percentage of the cost, based on established CDCP fees and your adjusted family net income. The percentages paid by the patient are called co-payments. The co-payments are the percentage of the treatment fee that is NOT covered under the CDCP. Co-payments will be paid by the patient directly to the oral health care provider at the time of treatment.
EXAMPLE: RECALL AND CLEANING
ONTARIO FEE GUIDE $307.00 | CDCP FEE GUIDE $271.55
ADJUSTED ANNUAL FAMILY NET INCOME | CDCP PAYMENT | CO-PAYMENT
Under $70,000 | $271.55 | $35.45
Between $70,000 and $79,999 | $162.93 | $144.07
Between $80,000 and $89,999 | $108.62 | $198.38
Some of the services covered under the CDCP will require pre-authorization before the treatment will be granted coverage. Services requiring pre-authorization will become available in November 2024. |  | Our staff is happy to provide you with an estimate for your co-payment before your dental treatment.
I understand co-payment is due at the time of treatment.
NAME: [Full Name Response] |  | DATE: [mm/dd/yyyy]
© 2026 David Gouett Dentistry. This record is protected under PIPEDA and PHIPA legislation. Unauthorized disclosure of this clinical information is strictly prohibited.