ADA Dental Registration

ADA Registration

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Accreditation Contact Details

ADA Membership Number(Required)

ADA Member Contact(Required)

Prefix First Last

Practice Definitions

Initial Practice Fee for ADA Members: A private practice must have at least one (1) full fee-paying ADA Member working at each registered practice site to be eligible to access the discounted ADA Member fee for re-accreditation.

Multiple Practice Discount: Providing the same management systems, policies, and procedures are implemented in each practice site, a discount of 15% will apply when you register more than one practice.

Outreach Location: Where dental services are provided at an independent outreach location that operates less than 20 hours per month, an additional site certificate fee of $100.00 will apply to issue an accreditation certificate for that location.

Are you part of a dental network, corporate or standalone practice?(Required)

Dental network / Corporate name(Required)

How many sites are you registering for?(Required)

Preferred Accreditation Contact(Required)

Prefix First Last

Practice Owner Name(Required)

Prefix First Last

Mobile(Required)

First Practice Details

Practice Name(Required)

Trading Name(Required)

ABN(Required)

Email(Required)

Website

Phone(Required)

Fax

Preferred method of receiving information(Required)

Address of Head Office

Street Address(Required)

Address Line 1 Address Line 2 Suburb State Postcode Country

Postal Address(Required)

Address Line 1 Address Line 2 Suburb State Postcode Country

Demographic Details

Are you part of a corporate entity?(Required)

Yes

Corporate Name(Required)

Accreditation Type

Profession Type(Required)

Pricing and Payment

The initial practice fee is $1,500 (ex GST). If you register additional practices, a discounted rate of $1,000 (ex GST) per site applies, provided that the same management systems, policies, and procedures are implemented across all locations.

For outreach locations operating less than 20 hours per month, an additional site certificate fee of $100 (ex GST) applies.

If you have more than 10 practice sites, please contact QIP to discuss a customised quote tailored to your organisation's needs.

How would you like to make payment(Required)

An invoice will be generated and emailed to you within 2 business days.

Please click here to make a credit card payment.

ADA Dental Registration

ADA Dental Registration

ADA Registration

Next Steps: Sync an Email Add-On

Accreditation Contact Details

First Practice Details

Address of Head Office

Demographic Details

Accreditation Type

Pricing and Payment

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