Mobile Adolescent Dental Enrolment Form 2024
We provide FREE yearly treatment for adolescents up until their 18th birthday. We service the following colleges: Tauranga Boys, Tauranga Girls, Otumoetai, Papamoa and Te Puke. 

Our Mobile Dental Unit will be onsite at Tauranga Boys' College part time during terms one and two treating students who are enrolled with us. 

PLEASE NOTE: Students can only be enrolled with ONE Dental Provider.

If you would like your son to be seen by our Community Dental Service at School, then please complete this consent form.
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E-mailadres *
Patients Details
Please give accurate details for the patient (your son).
Patients Full Name *
Date of Birth *
MM
/
DD
/
JJJJ
Gender *
Current School *
NHI (if known)
Ethnicity *
Verplicht
Address *
The primary/main residential address for your son.
Contact phone number  *
Volgende
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