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    DipImp Application Form March 2022

    Uploaded by

    Neeta Joseph John
    This document provides information and instructions for candidates taking the Diploma in Implant Dentistry Exam on July 21-22, 2022. It lists the submission deadline, contact details required from candidates, included exam fee information, required documentation to submit such as medical history, treatment plans, imaging, and a signed clinical log book. It also provides privacy statement details and contact information for submitting exam cases electronically or by other means.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    DipImp Application Form March 2022

    Uploaded by

    Neeta Joseph John
    21 views2 pages
    This document provides information and instructions for candidates taking the Diploma in Implant Dentistry Exam on July 21-22, 2022. It lists the submission deadline, contact details required from candidates, included exam fee information, required documentation to submit such as medical history, treatment plans, imaging, and a signed clinical log book. It also provides privacy statement details and contact information for submitting exam cases electronically or by other means.

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    DipImp application form March 2022

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    This document provides information and instructions for candidates taking the Diploma in Implant Dentistry Exam on July 21-22, 2022. It lists the submission deadline, contact details required from candidates, included exam fee information, required documentation to submit such as medical history, treatment plans, imaging, and a signed clinical log book. It also provides privacy statement details and contact information for submitting exam cases electronically or by other means.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    21 views2 pages

    DipImp Application Form March 2022

    Uploaded by

    Neeta Joseph John
    This document provides information and instructions for candidates taking the Diploma in Implant Dentistry Exam on July 21-22, 2022. It lists the submission deadline, contact details required from candidates, included exam fee information, required documentation to submit such as medical history, treatment plans, imaging, and a signed clinical log book. It also provides privacy statement details and contact information for submitting exam cases electronically or by other means.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    DIPLOMA IN IMPLANT DENTISTRY EXAM

    Date of Exam 21-22 July 2022


    Submission Deadline 9 June 2022
    Contact details:
    Last name in full Other names
    (as you wish it to appear (as you wish them to appear
    on a certificate) on a certificate)
    Title: GDC no.
    Date of birth: Mobile Number:
    Email address: Home Phone Number:
    Address:

    Work Address (for return of cases):

    *Exam fee is included within the course fee. No separate exam fee is expected for the first sitting; however there will be a fee for any subsequent sittings.

    Please include the following in your submission

    Description Enclosed
    Medical history of patient
    Completed consultation forms (record of clinical
    examination report)

    Documents (written treatment plan and correspondence


    including patient consent)

    Diagnostic imaging (x rays)

    Laboratory records (dockets and prescriptions)

    Photographic records

    Contemporaneous clinical records

    Record of bio-materials

    Electronic Copy of Cases (USB or CD)


    Clinical Log Book (signed off by tutor and Faculty)

    Diploma in Implant Dentistry Exam


    Surgical and Dental Examinations Department, Royal College of Surgeons of England
    35-43 Lincoln’s Inn Fields, London, WC2A 3PE
    Tel: 0207 869 6272 Fax: 0207 869 6290 Email: [email protected]
    PLEASE NOTE: For submission of cases, please contact us at [email protected] and we
    will advise you of how to submit your cases electronically

    PRIVACY STATEMENT
    The information you have given on this form will be held by the Examinations Department of the
    Royal College of Surgeons of England on a compartmented secure server in accordance with the
    General Data Protection Regulation (GDPR), and will be used only in connection with the purposes
    that you originally contacted us for. The information is kept by The Royal College of Surgeons of
    England and will be available to all members of staff within the same department, and will not be
    shared throughout the wider organisation unless instructed otherwise. Your information will be held in
    line with the relevant College retention schedule.

    Diploma in Implant Dentistry Exam


    Surgical and Dental Examinations Department, Royal College of Surgeons of England
    35-43 Lincoln’s Inn Fields, London, WC2A 3PE
    Tel: 0207 869 6272 Fax: 0207 869 6290 Email: [email protected]

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