Update Contact Information - College of Dental Surgeons of Alberta

Address/Phone/Fax and Email Updates

Under Section 38 of the Health Professions Act, all regulated members are required to provide current contact home and work addresses, phone numbers, fax numbers and email addresses.

Name*

Prefix First Last

Select the contact infomation that you are updating.*

Home Address
Home Phone
Cell Number
Home Email
Business Address
Business Phone
Business Fax
Business Email

Business Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone*

Business Ext

Business Fax*

Business Email*

Enter Email Confirm Email

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Cell*

Home Email*

Enter Email Confirm Email

Date Effective*

The date this contact information goes into effect. Up to 4 weeks in advance.

Mail requested to be sent to*

Home
Business

**Please note that if you choose your home address as your default, mail will be sent to your home and you will not be placed on the public website dentist locator, for privacy purposes.

Consent*

By submitting this form electronically, I acknowledge and agree that the contents are true and complete as if I had signed the document in writing. I declare that the contents of this form are true and complete and I understand and agree that if I make a false or misleading statement or representation in my registration, I will be deemed to not have satisfied the requirements of registration. I further understand and agree that making a false or misleading statement to the Alberta Dental Association and College may constitute unprofessional conduct.*