*By submitting this form, you consent that Canaan Dental Surgery may collect, use, and disclose your personal data, as provided in this registration form, for the following purposes in accordance with the Personal Data Protection Act 2012:
(a) To provide dental services to you;
(b) To facilitate communications between you and our personnel;
(c) For communication with care providers and specialists within and outside of Canaan Dental for the continuation of your care;
(d) For communication and claims purpose with various insurance companies and government agencies such as CPF Board (Medisave), CHAS, etc.