Online registration Please note, appointments are 3 hours in length and often more than one appointment is required. Also, it may be several 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* MM slash DD slash YYYY Phone*Email* Is there another family member you would like to add? Yes Family member informationNameBirthday 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 referral Facebook page Brochures Newspaper Ad Internet Community agency Oral Health Unit/Healthy Smiles Other How did you hear of our dental clinic?PhoneThis field is for validation purposes and should be left unchanged.