Online application

Personal details

Qualification

Declarations

Equality and diversity

Direct Debit

Pre-application payment

Download application

Personal details

Please provide your personal details including your name, address, email and telephone numbers.

About you

* Required fields

Title*

First name*

Middle name

Last name (in full)*

Is the name on your identification document (ID) and qualification certificate the same name as this application?*

Yes

Previous Last name

Gender*

Female

Male

Date of birth*

Nationality*

Address

Postcode*

Start typing your postal code to search your address, ensure you select your country.

Building name

Address line 1

Address line 2

Address line 3

City/Town

County/State

Postcode

Country

Please ensure your address and contact details are updated should they change. Details on how this can be done will be provided.

If you are successfully registered to the GDC’s dental registers, we may publish your registered address on the GDC’s online register in the future. Please see the guidance provided with your application for further information on the publication of personal information.

Contact

Email address*

Confirm email address*

Mobile phone*

Home phone

Work phone

If overseas, please include the full number including STD codes.

Cancel

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