Practice Name Registration Application Form

Fill out the form to request approval of a practice name by the College. You can also review the College's Practice Advisory on Practice Names. Please do not use special characters (e.g. comma, underscore, brackets, or parenthesis) when filling out the form.

We do not grant the exclusive right to use practice names. Our approval of a practice name should not be construed in any way to be a grant of the right to use such name at law.

Consult with the Ministry of Government Services and your lawyer to determine whether this name has been registered with the Ministry and/or has exclusivity secured by law.

Error : Practice Name is required Error : Please include an address Error : Please provide a city name Error : Please choose a province Error : Please follow the 6 character format of alternating letters and numbers (eg. M4W 1T1). Error : Please include a minimum of 10 digits for the phone number (eg (416) 961-6555). Error : Please include a minimum of 10 digits for the fax number (eg (416) 961-5814). Error : Please include an email in the correct format (eg. info@rcdso.org) Error : Reason is required

For new practices, indicate date of opening Error : Opening Date is required

Please list the full names of all dentists practicing at this location

For each dentist, please list the RCDSO registration number after each dentist’s name; indicate whether the dentist listed is the Principal (P) dentist or an Associate (A); and if this office will be the primary office address for each of the listed dentists.

Error : Full Name is required Error : Registration Number is required

Principal or AssociateMandatory Error : Indicate principal/associate

Dentist's Primary AddressMandatory Error : Indicate primary/not primary

Add Dentist

: Indicate whether any of the dentists practice at any other location

Error : Applicant Name is required

Please correct the ${amount} error(s) detected below.

Your application has been submitted!