Application image

To receive our dental services, you must complete an application and verification process. This includes the completion of four forms and the verification that your family income is less than $42,000/year.

The new Federal Government Canadian Dental Care Plan (CDCP) comes into effect in May 2024 and any new patient who is registered with CDCP will also need to complete our  application and verification process. The reason for this is that CDCP patients incomes vary between $70,000 and $90,000 and we are only able to accept patients at this time in our clinic who have incomes up to $42,000. Other patients, including families over that amount will have to find a regular fee dental clinic.

To determine if you qualify for the new Canadian Dental Care Plan (CDCP), go to your local Federal Government Service centre or go to their website > > >
Once approved under CDCP, complete our application and verification process.
The “CDCP welcome letter” has the effective date of coverage, 
bring this letter when going to the Verification Centre.

New clients with a net family income under $42,000 will register at one of these
Verification Centres:
As printing is not available there, bring paper copies of any forms you have filled out from the website. Forms will also be available on site.

Nelson – Community First Health Co-op,  518 Lake St., Drop-in Tuesdays from 1:00–3:00 pm.
Trail – Please phone Esther Brown for an appointment: 250-921-5484
Castlegar – Community Harvest Food Bank. Please phone for appointment: 250-608-2227.
Kaslo Kaslo Community Services. Please phone 250-353-7691 for an appointment Monday to Thursday, 9:00 am –4:00 pm.
or Kaslo Primary Care Centre on Tuesdays and Thursdays. Please phone for an appointment with Jenny Hide: 250-353-2291.
Circle of Indigenous Nations — contact Sage Laboucan: 250-608-4552; fax: 250-399-0731 –; Josie Moro for Grand Forks and Boundary: 250-444-9599 –; Katie Rumbolt for W. Kootenay and Boundary acute care sites: 250-551-4395 –

The forms are available online below and can be downloaded and completed as a fillable PDF document on your computer and then printed, or printed and completed by hand. Either way, these form must be reviewed by our registrar at one
of our Verification Centres noted above.

Proof of income (by your last income tax return document or assessment form)
or proof that you are on a Ministry program must be provided.

After your Application Form has been verified, it will be sent, with the other three forms to the Clinic. You will be given a slip of paper with the date one week from that day and the clinic phone number. You are  to phone the clinic any time after the written date to ask for an appointment..


Application Form

This form must be verified at your registration appointment before you can receive dental services. 

Medical History

Complete this form and bring it to your registration appointment.

Dental History

Complete this form and bring it to your registration appointment.

Patient Agreement

This must be accepted to confirm your responsibilities. Complete this form and bring it to your registration appointment.