Making an appointment

Would you like a free general dental check-up?

You can add your name to our waitlist for dental care by completing the form below or by phoning your closest clinic.
The length of the waiting time can vary.
When your name reaches the top of the waitlist, a letter offering dental care will be sent to the address you have provided (please advise us if your address changes).
Costs may apply for further dental treatment.

Have an urgent dental problem?

Please call your closest clinic or see Emergency dental care.

To add your name to our waitlist for dental care you must meet the following criteria:

Live in South Australia
Be aged 18 or over
Have a current Health Care Card or Pensioner Concession Card in your name, and
It has been 12 months since your last SA Dental general course of care.

You do not need to resubmit this form if you have recently added your name to our waitlist.

For more information about dental services for Aboriginal and Torres Strait Islander clients please visit our Aboriginal Oral Health Program (AOHP).

First name

Last name

Date of birth

Postal address

Address

Suburb

Postal Code

Phone number (mobile is preferred)

Email address

A confirmation will be sent to this address.

Customer Reference Number (CRN) (with letter)

10 characters left

Concession card (expiry date)

Please read the following & give your consent for SA Dental to check your current concession card before submitting this form.

Agree

I authorise:
1. SA Dental to use Centrelink Confirmation eServices to perform a Centrelink/DVA enquiry of my Centrelink or Department of Veteran’s Affairs customer details and concession card status to enable the business to determine if I qualify for a concession, rebate or service.
2. The Australian Government Department of Human Services (the department) to provide the results of that enquiry to SA Dental.

Agree

I understand that:
1. The department will disclose personal information to SA Dental, including my name, address, payment and concession card type, and status to confirm my eligibility for public dental care.
2. This consent, once signed, remains valid while I am a customer of SA Dental unless I withdraw it by contacting SA Dental or the department.
3. I can get proof of my circumstances/details from the department and provide it to SA Dental so my eligibility for public dental care can be determined.
4. If I withdraw my consent or do not alternatively provide proof of my circumstance/details, I may not be eligible for the dental service provided by SA Dental.

Statement of Acknowledgement

Menu

Making an appointment

Making an appointment

Would you like a free general dental check-up?

Have an urgent dental problem?

To add your name to our waitlist for dental care you must meet the following criteria:

For more information about dental services for Aboriginal and Torres Strait Islander clients please visit our Aboriginal Oral Health Program (AOHP).

Please read the following & give your consent for SA Dental to check your current concession card before submitting this form.