top of page
香港大學牙醫學院
+852 3979 9191
香港皇后大道西460號翰林峰2樓
關於
專科
牙髓治療科
植齒科
口腔頜面外科
矯齒科
兒童牙科
牙周病學
口腔修復學
預約
收費
招募
轉介
聯絡我們
More
Use tab to navigate through the menu items.
Clinical Privileges Application Form
English Full Name
Title (Please refer to the Clinical Privilege Table)(e.g. Honorary Dental Officer)
Contact Number
Email
Copy of Student Enrolment / Appointment record at Faculty of Dentistry
Upload File
Image only (Max 15MB)
Copy of Licensure
Upload File
Image only (Max 15MB)
Copy of Dentist Registration
Upload File
Image only (Max 15MB)
Copy of Liability Insurance (MPS)
Upload File
Image only (Max 15MB)
For Faculty Staff, please submit your Clinical Outside Practice Eligibility Letter
Upload File
Image only (Max 15MB)
Image of other relevant documents
Upload File
Image only (Max 15MB)
Pdf of other relevant documents
Upload File
PDF only (Max 15MB)
Other remarks for your application
I, the applicant, hereby declare and certify that the documents uploaded for this application are true and accurate copies of the original documents. I understand that I will bear full responsibility and liability for any false or fraudulent documents submitted.
Agree
Disagree
Submit
Thanks for submitting!
bottom of page