Personal Details
Full Forenames*
Surname*
Entering your professional registration number , such as your GDC number ,will authenticate your status and allow access to restricted areas of the site. This can be added at  a later date if you do not have it on hand.
Professional Registration Number**
Professional Status
Professional Status†	Select one of the following Dental Surgeon Hygienist Dental Therapist Dental Surgery Assistant Practice Manager Dental Technician Dental Trade Student Not Applicable
Position†  (if Dental Surgeon)	Select one of the following Partner Principal Associate Clinical Assistant VDP Not Applicable
Title in Hospital†	Select one of the following Professor Senior Lecturer Consultant Registrar House Officer Not Applicable
Speciality†	Select one of the following Oral Medicine Oral Surgery Orthodontics Paedodontics Periodonotics Prosthetics Restorative Not Applicable
( †) Please ensure every box has an entry. Please enter 'Not Applicable' if the section does not apply to you.
Log-on and E-Mail Details
The details below will allow you future access to the site and will also create an e-mail account for you.  The user name you choose should not contain any spaces and you should make a separate note of both your user name and password should you need to refer to it in the future.  Once you have chosen a user name this will form part of your e-mail address i.e:If you choose ‘jbloggs’ as your user name, your corresponding e-mail address will be: jbloggs@dentalnetuk.com. If this name has already been registered, then try again, perhaps adding a number after your chosen name
User Name*
Password*
Re-enter Password*
IMPORTANT: Please ensure that your secret question can ONLY be answered by yourself and NO ONE else. Otherwise this could compromise the security of the portal as well as giving unauthorised access to your personal e-mail account.
Hint Question*
Hint Answer*
Additional Security
Date Of Birth*(dd/mm/yyyy)
Mother's Maiden Name
Your practice website
If you have already received your FREE practice Web site from DentalNet UK, then please enter the name of your site in the space provided. We will then allow patients to contact you through your Web site, should you wish. These messages will be forwarded to the e-mail account created for you and patients will not see your e-mail address.
Name of your website www.dentalnet.uk/
(*) The fields indicated with an asterisk are required to complete this transaction floxin.