School Dental Van Visit

This form is intended for schools only to fill out to register their interest in having our Dental Van at their school. Fill out the form, and we will be in touch to schedule a Fairy Visit!

First Name *

Last Name *

Email Address *

School Name *

Approx how many children in the school? *

Name | Email | Phone Number of School Groundsmen

What is your preferred month/week that we would ideally visit? *

Is power provided or will we need our generator? *

What are your school times: Start/Finish & Lunch Times? *

What is your school assembly day/time? *

What is the best day to organise an in-person meeting? *

Any other comments or questions?

Form Fill Out Date *