DIPLOMA IN IMPLANT DENTISTRY EXAM

Date of Exam 21-22 July 2022

Submission Deadline 9 June 2022
Contact details:
Last name in full Other names
(as you wish it to appear (as you wish them to appear
on a certificate) on a certificate)
Title: GDC no.
Date of birth: Mobile Number:
Email address: Home Phone Number:
Address:

Work Address (for return of cases):

*Exam fee is included within the course fee. No separate exam fee is expected for the first sitting; however there will be a fee for any subsequent sittings.

Please include the following in your submission

Description Enclosed
Medical history of patient
Completed consultation forms (record of clinical
examination report)

Documents (written treatment plan and correspondence

including patient consent)

Diagnostic imaging (x rays)

Laboratory records (dockets and prescriptions)

Photographic records

Contemporaneous clinical records

Record of bio-materials

Electronic Copy of Cases (USB or CD)

Clinical Log Book (signed off by tutor and Faculty)

Diploma in Implant Dentistry Exam

Surgical and Dental Examinations Department, Royal College of Surgeons of England
35-43 Lincoln’s Inn Fields, London, WC2A 3PE
Tel: 0207 869 6272 Fax: 0207 869 6290 Email: dentalexams@rcseng.ac.uk
PLEASE NOTE: For submission of cases, please contact us at dentalexams@rcseng.ac.uk and we
will advise you of how to submit your cases electronically

PRIVACY STATEMENT
The information you have given on this form will be held by the Examinations Department of the
Royal College of Surgeons of England on a compartmented secure server in accordance with the
General Data Protection Regulation (GDPR), and will be used only in connection with the purposes
that you originally contacted us for. The information is kept by The Royal College of Surgeons of
England and will be available to all members of staff within the same department, and will not be
shared throughout the wider organisation unless instructed otherwise. Your information will be held in
line with the relevant College retention schedule.

Diploma in Implant Dentistry Exam

Surgical and Dental Examinations Department, Royal College of Surgeons of England
35-43 Lincoln’s Inn Fields, London, WC2A 3PE
Tel: 0207 869 6272 Fax: 0207 869 6290 Email: dentalexams@rcseng.ac.uk