Become a patient

Part A. Information for prospective patients

Thank you for your interest in seeking treatment in the undergraduate teaching clinic at the Dr. Gerald Niznick College of Dentistry (College). We provide high quality, comprehensive care for about 50 per cent the cost of a private office. All treatment is provided by College learners of dentistry and dental hygiene, under the supervision of a licensed dentist or registered dental hygienist.

Educational institution

The College is an educational institution. All patient applicants must be deemed suitable for treatment by College learners of dentistry and dental hygiene (i.e., students) for educational purposes. A patient may be dismissed at any point if their treatment is deemed to complex or does not contribute to the educational value of the institution.

Consent and waiver

All accepted patients must sign a consent and waiver form. They must also sign informed consent forms as required for certain treatment.

Fees

Patients must pay a non-refundable non-insured registration fee. Treatment costs are approximately half of private dental clinics – i.e., 50 per cent of the fees set out in the Manitoba dental association fee guide. The fees quoted by the College are subject to change, as treatment plans and may change from time to time, in the sole discretion of the College.

Payment

The patient must pay all fees on the date treatment is provided. For extensive procedures, one half of the total fee is required at the beginning of the appointment and the remainder payable at the end. Payment by personal cheque or American Express is not accepted.

Personal information

Patient personal information, including casts, x-rays and photos, are collected by the College for treatment, education and research. Any questions about access and privacy laws may be directed to the university’s Access and Privacy Officer at fippa@umanitoba.ca or through their office at 233 Elizabeth Dafoe library, Winnipeg, MB R3T 2N2.

Language of instruction and treatment

The language of instruction at the College is English. Unfortunately, the College is not able to provide interpreters, therefore, patients requiring assistance in English must bring their own interpreter to each appointment.

Treatment and timing

Treatment is provided by College learners of dentistry and dental hygiene, under the supervision of a licensed dentist or registered dental hygienist. The treatment process is slower than in a private practice. It may take several weeks to arrange for your initial appointment if accepted. Each appointment is scheduled for three hours. It may take over a year to complete the agreed upon treatment plan. General dentistry is available between September to April. Service is limited during the summer months. As a patient of the College, you are agreeing to have comprehensive care which may include cleanings, fillings, extractions etc.

Appointment reminder system

The College uses an electronic appointment reminder system (via email, text or telephone) to confirm appointments. Patients must inform the College of any changes in their contact information. Please be on time for your appointments or cancel at least one day in advance.

Safe and secure environment

Patients must comply with all College requirements intended to ensure a safe and secure environment including all policies regarding needle stick injuries and blood borne pathogens. Failure to comply with the College’s rules and requests to ensure a safe and secure environment will result in the appointment being cancelled and potential dismissal as a College patient. Please ensure that you behave in an appropriate manner at all times.

Medical emergencies

If a patient requires emergency medical care during an appointment, the College will contact 911 for assistance. Any transportation to hospital will be by ambulance. The patient is responsible for ambulance costs.

 

Part B. Patient application

Has the applicant attended one of our College clinics in the past?
This is an application for:

Patient's personal information

Gender

Patient's contact information

Please format as 204-123-4567.
Phone type
Street address/PO box number
City/town

Please be advised that our webform is currently experiencing difficulties receiving submissions from @aol.com, @yahoo.com and @yahoo.ca email addresses. We apologize for any inconvenience this may cause. If possible, we kindly request using alternative email providers to submit information via our webform as we work to resolve the issue.

Emergency contact

Please format as 204-123-4567.

Insurance

Type of insurance

Private insurance information

Who is the policy holder?

Government insurance information

Type of government insurance

How did you hear about us?

Terms and conditions

In consideration of receiving treatment by the University of Manitoba’s Dr. Gerald Niznick College of Dentistry ("College"), I acknowledge and agree as follows:

  1. The College’s main purpose is to train and educate learners of dentistry and dental hygiene.  I consent to treatment by such learners, under the supervision of a licensed dentist and/or registered dental hygienist.
  2. Treatment at the College will be slower than in a private dental practice, especially during the summer months.
  3. I accept the risks associated with participating as a patient of the College, including the fact that treatment is provided by College learners and may not proceed in a timely manner.
  4. The College relies on information I provide for determining my oral health care treatment, including information I provide about my dental history and medical history.
  5. I will comply with all oral health and oral hygiene recommendations and treatment instructions provided by the College.
  6. I confirm there is no guarantee that any treatment provided to me by the College will be curative and/or successful.
  7. I understand there is a risk of failure, relapse or worsening of my present dental condition after treatment by the College.
  8. I release the University, the College, its learners, staff and representatives from any and all claims for injuries, damages or expenses I may suffer due to my participation as a patient of the College.  This release also applies to anyone making such claims on my behalf. This release shall continue in effect even after I am no longer a College patient.
  9. I will pay all fees due to the College on the date I receive treatment.  
  10. I will cooperate with the College’s learners and staff to ensure a safe and secure environment. I will comply with all College requirements intended to ensure a safe and secure environment including all policies regarding needle stick injuries and blood borne pathogens.  I understand my failure to act in an appropriate manner may result in my dismissal as a patient of the College.
  11. The College may, without cause, provide me with notice of termination of services/dismissal as a patient, with seven days’ notice, either verbally or in writing.
  12. The College will use my personal information, e.g., charts, molds, photographs and radiographs (x-rays) for treatment, teaching and research purposes.  Telephone conversations may be recorded for quality assurance and teaching purposes and to seek out consultations from my treating physicians for the purposes of dental treatment. Telephone conversations may be recorded for quality assurance and teaching purposes.
  13. The College uses an electronic appointment reminder system (via email, text or telephone). I will keep my contact information on file with the College up to date.
Notice Regarding Collection, Use, and Disclosure of Personal Health Information by the University

Your personal health information is being collected under the authority of The University of Manitoba Act. The information you provide will be used by the University for the purpose of setting up your patient record with the Dr. Gerald Niznick College of Dentistry and booking your initial screening. Your personal health information may be disclosed to insurance companies for billing purposes. Your personal health information will not be used or disclosed for other purposes, unless permitted by The Personal Health Information Act (PHIA). If you have any questions about the collection of your personal health information, contact the Access & Privacy Office (tel. 204-474-9462), 233 Elizabeth Dafoe Library, University of Manitoba, Winnipeg, MB, R3T 2N2.



Contact us

Dr. Gerald Niznick College of Dentistry
D113, 780 Bannatyne Avenue
University of Manitoba, Bannatyne Campus
Winnipeg, MB R3E 0W2 Canada

info_dent@umanitoba.ca
204-789-3497
204-789-3950