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Notification Form for Changing a Practice Name

The below form is a requirement for dental hygienists who are changing the name of a practice they own or operate.

As per College Bylaws:

At least 90 days prior to opening, operating, acquiring, adding a component to, or moving a dental hygiene practice, a regulated member is required to provide written notification to the College of the following information:

(a) the practice name;
(b) phone number;
(c) email address;
(d) complete business address;
(e) names of any additional owners;
(f) any other information requested by the Registrar.

A regulated member is required to provide written notification to the College of any change in the ownership interests or changes to information listed in (1) above at least 90 days prior to the anticipated change.

Please complete and submit this form.

If you responded Yes to the above question, please provide full name(s) and registration number(s), if applicable. Any additional business owners/operators who are registered dental hygienists must complete this form in full and submit it separately.

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