Patient registrations

For patients looking to receive care from The Dental Truck, please complete the form below:

  • Date Format: MM slash DD slash YYYY
  • Please provide as much detail as you can about: - any medical conditions you may have - any medications you are taking - any history of recreational drug use - any history of allergies

The time for action is now!

Donate to The Dental Truck

and give a smile to someone who needs it

Copyright 2019 by The Dental Truck Ltd

The Dental Truck Ltd is registered as a charity with the Australian Charities and Not-for-profits Commission (ACNC).