Application Form

Please fill out the form below to join FDC.

Details of professional qualifications*

How many dentists work at the practice?*

If you have a satellite practice or practices please complete details below:

Are there any complaints or legal issues in respect of you as a dentist or circumstances that could affect you professionally
- Current
- Pending
- Past

Yes

If you have answers "Yes" please give details/dates/circumstance/outcome below:

Please upload a copy of your GDC Registration and PI Insurance documents

GDC Registration File

PI Insurance

To comply with data protection regulations (2018), we are unable to store and use your information unless you give us your permission. Please select Yes to allow this. View our Privacy and Data Policy for details.

Application Form

Children's Plan

Full Care Plan

Maintenance Plan