Dental Hygiene Clinic Waitlist Signup If you see this don't fill out this input box.First Name* Last Name* Phone*This is the number we will use to contact you if you are selected for an appointment. Date of Birth* Date of Last Dental Cleaning*Please select the date of your most recent dental cleaning. If you are unsure, please approximate as closely as possible. Availability*Provide the days and times you are generally available. Please be prepared to commit to as many four-hour appointments as your care requires. Every step of the process is checked by a dentist or instructor, so patients typically require one to five visits. Form UUID Site Name Submit Clear