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Partnership Confirmation eForm

To be completed by a staff member from the school or childcare center - ONLY

1

School Details

2

Program Details

3

Contact Person

4

Declaration

School Details

This Application is for a *

School Childcare / Kindergarten Others

School Name *

Phone

Email

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Use above address as postal address

Address will be used to post the consent forms. Please confirm address entered is correct.

Victorian Mobile Dental Health

Administration office
17/43 Scanlon Dr, Epping VIC

Dental care at participating schools.
No patient appointments at this office.

+61 483 102 562
admin@vmdh.com.au

Mon–Fri, 9:00am–5:00pm

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Accreditation

In the spirit of reconciliation we acknowledge the Traditional Custodians of country throughout Australia and their connections to land, sea and community. We pay our respect to their Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today.