CEC | Update Your Office Information

Please choose your office:

Dentist Details

Dentist Full Name

DentalVision provider number (6 digits)

What does the doctor want to be called? (i.e. Dr. Steven smith likes patients to call him Dr. Steve)

Dentist Emergency Number

Permanent or Locum?

Permanent

Locum

When did this doctor start at your location?

If the doctor is exiting, what is their last day seeing patients?

Is the doctor currently or going on leave?

Yes

Leave start date:

Leave end date:

Hygienist First Name

DentalVision provider number (6 digits)

Does the hygienist have a nickname?

When did this hygienist start at your location?

If the hygienist is exiting, what is their last day seeing patients?

Is the hygienist currently or going on leave?

Yes

Leave start date:

Leave end date: