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Does your practice offer dental memberships? Get it listed on the Dental Membership Marketplace!
Need Help With Your Membership?
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3
- Practice Details
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Enter Practice Details
Practice Name
*
Doctor(s) in Practice
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Practice Address
*
Street Address
Address Line 2
City
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Armed Forces Americas
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State
ZIP Code
Main Practice Website URL
*
Membership Specific Page URL
Practice Phone
*
Practice Email
*
Type of Practice
*
Please Select
General
Ortho
Pediatrics
Perio
Short Description About Your Practice
Membership Details
Do you currently have membership plans in your practice?
*
Yes
No
Do you manage memberships manually (Spreadsheets/PMS tracking) OR use 3rd party software
*
Manually
3rd Party Software
What software do you use?
*
Please Select
Smile Advantage
Kleer
Illumitrac
Plan Forward
Boomcloud
DentalHQ
Pearly
Other
Do you require patients to use a Credit Card?
*
Yes
No
Do you offer Annual paid plans or monthly or both?
*
Please Select
Annual paid plans
Monthly Plans
Both
How many members do you have?
*
0-25
50-100
200-400
500+
Your Contact Information
Responsible Party in the Office
Name
*
First
Last
Email
*
Phone
*
Phone
This field is for validation purposes and should be left unchanged.
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