Practitioner Registration

Register to Become an Approved MySmilePlan Provider

To register for MySmilePlan and become an Approved Provider, please complete the registration form.

We aim to contact you within 2 business days following your submission of registration.

Practice Details

(no spaces)

Contact Details

The URL that you want the MySmilePlan website to link to

Bank Details:

Must be 6 digits long

Maximum 12 digits long

General Details

  1. Does your practice currently utilise any other third party payment plan systems?
  2. Does your practice use HICAPS?
  3. What type of practice are you?

  4. How many dental chairs do you currently operate?
  5. What is your estimated revenue for the current financial year?
  6. Why are you interested in providing MySmilePlan payment plans to your patients?
    Please choose the 3 most relevant to you