Denplan Excel Accreditation application

All dentists registering for Denplan Excel Accreditation must first become Denplan members. If you are not already a Denplan member, you can apply for membership now.

Please note: fields marked Required Field Indicator must be completed

Programme details

Programme applying for Required

Please select the programme(s) you wish to include in your application and then continue to complete the application.

Your details

Denplan membership No Required

GDC No. Required

Title Required

First name Required

Surname Required

Practice name Required

Address line 1 Required

Town Required

County Required

Postcode Required

Email address Required

Telephone No. Required

Do you wish to be accredited at another practice?

Yes No

Practice name Required

Address line 1 Required

Town Required

County Required

Postcode Required

Email address Required

Telephone No. Required

Dentists applying for accreditation

Please give names, GDC numbers and Denplan membership numbers of all Denplan member dentists in the practice (including yourself) who wish to become Excel accredited.

Declaration

I agree to pay a Denplan Excel start up fee of £100 per dentist per practice. We will contact you shortly to confirm your preferred method of payment (cheque, invoice, monthly report).

I agree to pay a monthly fee based on my Denplan patient numbers. We will contact you once you are accredited to confirm your preferred method of payment (monthly report, Direct Debit, or annually in advance by cheque or credit card).

I have read and agree to comply with the Terms and Conditions of Denplan Excel Accreditation.

I have read and agree to comply with the Practice Commitment.

Please read Denplan's Data Protection statement.
We may contact you about the products and services which we feel may be of interest to you, by post or by telephone. Please tick the box if you do NOT wish us to do this.

Complete form

Denplan Excel Accreditation application

Thank you for submitting your Denplan Excel Accreditation application.