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Questions? Please contact:

Courtney Razmus
Administrator, Registration, Licensing & Corporations
(204) 560-0845
[email protected]


  • Becoming Registered and Licensed in Manitoba
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    • FAQ
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Provisional Dental Assistant Registration Forms

 

Review the Instructional Guide to Completing Dental Assistant Registration Application Form.

 

Download the complete Provisional Registration as a Dental Assistant Package

What's inside the package:

  1. Checklist for Provisional Registration as a Dental Assistant
  2. Registered Dental Assistant Initial Registration Application
  3. Consent to Release Health Information Form
  4. Consent for Personal Information Form
  5. Declaration of Commitment to Ethical Practice and the Public Interest
  6. Declaration and Agreement of Applicant for Provisional Registration as a Dental Assistant
  7. Agreement on Condition for Dental Assistant Registration for a Recent Graduate

Manitoba Dental Association

202 - 1735 Corydon Avenue
Winnipeg, Manitoba | R3N 0K4

Phone: (204) 988-5300

Fax: (204) 988-5310

Email: [email protected]

Hours

Monday to Friday: 8:30 am to 4:30 pm

Saturday to Sunday: Closed

Holidays: Closed

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Corporate Member of the Canadian Dental Association.