Online registration Please note, appointments are 2.5 hours in length and 3-5 appointments will be required. Also, it may be 6-8 weeks before you hear about an appointment. If you have been on the list for a while without being contacted please email dentalclinic@durhamcollege.ca. Name* First Last Birthdate* YYYY dash MM dash DD Phone*Email* Is there another family member you would like to add? Yes Family Member 1 Name* First Last Family member 1 Birthdate* YYYY dash MM dash DD Family Member 2 Name First Last Family member 2 Birthdate YYYY dash MM dash DD Family Member 3 Name First Last Family member 3 Birthdate YYYY dash MM dash DD Family Member 4 Name First Last Family member 4 Birthdate YYYY dash MM dash DD Preferred method of contact* Email Phone When was your last dental cleaning?* Less than 6 months 6-12 months 1-2 years 3-5 years 5-10 years 10+ years Have you attended our clinic before?* Yes No How did you hear of our dental clinic?* Family/friend Facebook page Brochures Internet Community agency Oral Health Unit Other DC Student Ont Tech Student Alumni DC Employee Ont Tech Employe How did you hear of our dental clinic?What days and time work best for your schedule? (Please check the best day and time for your appointments)*Monday - 8:30 a.m.Monday - 1:30 p.m.Tuesday - 8:30 a.m.Tuesday - 5:30 p.m.Wednesday - 8:30 a.m.Wednesday - 1:30 p.m.Thursday - 1:30 p.m.Friday - 8:30 a.m.Friday - 1:30 p.m.These are the only available times for appointments. Hold the Control or Shift keys to select multiple dates.CommentsThis field is for validation purposes and should be left unchanged.
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