Are You an Independent Practitioner?*YesNoNote: this information will be shared publiclyType(s) of Hygienist Practice*A dental hygiene clinicA mobile dental hygienistA dental hygienist in Residential CareIndependentEducationResearchPublic HealthWork Category*Clinical PracticePublic HealthEducationMobile/ResidentialIndependentResearchAdministration/OtherBusiness Name* Hygienist First Name* Hygienist Last Name* Address* City* Province*BCALBERTAPostal Code* Phone* Fax E-mail Address* Website* Which professional association are you a member of*You must be a current member of the BCDHA or DHAA to belong to this website.BCDHA (British Columbia)DHAA (Alberta)What Area(s) Do You Service?*AlbertaCalgaryCentral AlbertaEdmontonNorthern AlbertaSouthern AlbertaBritish ColumbiaNorthern BCBC InteriorGreater VancouverFraser ValleyVancouver IslandGulf IslandsHandling Emergencies*YesNoWhat is your practice anniversary date?* Additional InformationAccount RegistrationUsername*Username must be without spaces or special characters Password* Confirm Password* Only fill in if you are not human Login
