Child Dental Service Registration

Child Dental Service Registration

Child 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 "Gender" is a mandatory field.
Info "Email Address" is a mandatory field.
Info "Email Address" must be a valid email address.
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 "Indigenous status" is a mandatory field.
Info "Medicare Number" is a mandatory field.
Info "Medicare Number" must be a number.
Info "Suffix" is a mandatory field.
Info "Expiry" is a mandatory field.
Info "Preffered Language" is a mandatory field.
Info "Country of Birth" is a mandatory field.
Info "Concession card type: drop down box" is a mandatory field.
Info "Card number" is a mandatory field.
Info "Expiry Date" is a mandatory field.
 

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]

Leave Feedback