Adult Dental Service Registration

Adult Dental Service Registration

Adults must have a Health care card or Pension card

Adult Dental Service Registration

Please do not use this from to access urgent care

Info "First name" is a mandatory field.
Info "Last name" is a mandatory field.
Info "Title" is a mandatory field.
Info "Date of birth" is a mandatory field.
Info "Address" is a mandatory field.
Info "Suburb" is a mandatory field.
Info "Contact number" is a mandatory field.
Info "Contact number" must be a number.
Info "Email address" is a mandatory field.
Info "Email address" must be a valid email address.

Please indicate whether you have natural teeth, dentures, a combination of both or no teeth or dentures.

Info "Teeth type" is a mandatory field.
Info "Indigenous status" is a mandatory field.
Info "Preferred language" is a mandatory field.
Info "Country of birth" is a mandatory field.
Info "Concession card type" is a mandatory field.
Info "Card number" is a mandatory field.
Info "Expiry date" is a mandatory field.
 

By submitting this registration you agree to be placed on the general care wait list for Bendigo Health Dental Services. Current waiting time is approximately six-nine months Please do not use this from to access urgent care.

Bendigo Health and Latrobe University work in partnership to provide a teaching facility within the service.

Contact Us

Location

100 Barnard Street, Bendigo, VIC, 3550

Phone

03 5454 6000

Email

[email protected]

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