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  Register Form
Please complete the information below as accurately as possible. Fields denoted with an asterisk (*) are mandatory.
 
  Membership Groups
This website is open to high street dental practices based in the UK (including Northern Ireland) which are NOT part of one of the following corporate groups - MyDentist (formerly IDH), OASIS, Southern Dental, Rodericks, BUPA, CFD, Portman, Genix and Perfect Smiles. We are also not able to offer access to the site for customers in the Dental Schools.

Please confirm if you are part of one of the following membership groups:

 
  Your Contact Details
Title:
If other, please specify:
   
First Name*  
Last Name*  
   
Email*    
Confirm Email*      
   
Work Tel No*  
Mobile Tel No: (Used for SMS notifications)

 

Protecting your privacy...
Your details will never be passed on to any third party in accordance with our privacy policy.

 
  Your place of work
Job Function*  
If other, please specify:  
   
Practice Type*  
Dental Practice Name*  
Address*  
 
Town*  
County*  
Postcode*  
Country*  
 
  Your Dealer
Your preferred Dentsply Sirona certified dealer
Preferred dealer account number:

Your alternative Dentsply Sirona certified dealer
 
  Your email preferences
I would like to receive points statements by email
I would like to receive occasional emails containing news and offers
 
Please untick the boxes above if you prefer not to receive these email communications
 
  Your login details
GDC No*  
  Your GDC number will be verified against our members database
  If you do not have a GDC number please provide the name of your lead dentist below and use their GDC number above.
Lead Dentist:

Password*      
  Passwords should be between 8 - 20 characters and ONLY consist of letters and numbers (A-Z, 0-9)
Confirm Password*  

    Please confirm you accept the terms and conditions*