Recurring Revenue Revolution - Dentist Onboarding Form

Let's Get Started!

Please take a few minutes to provide our web development and graphic design teams your office information.

We recommend you gather your logo file and any other digital marketing materials you would like to share. We do our best to match your SmileMore Dental Savings Plan brochure to other branded items in your practice.

Please enter your name(s) and practice name exactly as you would like it on your enrollment webpage and brochure.

Questions? Contact us at support@smilemore.marketing or call 844.443.7771

Thank you!

The SmileMore Marketing Team

Name of Person Completing This Form *

Email Address of Person Completing This Form *

Practice Name *

Section

Dentist Name(s) *

Add Remove

Practice Main Phone Number *

Website url *

Practice email address to display on your enrollment webpage *

Address

Address 1 *

Address 2

Country info

City *

State *

Zip *

practice logo

Practice logo upload

(Please only upload .jpg, or .png. if your logo file is an .AI or .EPS please email it to logos@smilemore.marketing.)

Practice Logo Upload

Maximum file size: 134.22MB

Please provide your hours of operation.

Monday

Start

End

Status

Closed

Tuesday

Start

End

Status

Closed

Wednesday

Start

End

Status

Closed

Thursday

Start

End

Status

Closed

Friday

Start

End

Status

Closed

Saturday

Start

End

Status

Closed

Sunday

Start

End

Status

Closed

Social Media Links

Facebook

Instagram

Twitter

E-mail address(es) for enrollment form and contact form to be sent

Section

Patient Contact Email Address *

Add Remove

Additional Information

Section

In addition to the information SmileMore Marketing will include on your webpage regarding your dental savings plan, is there any other information you would like to add?

In addition to the information SmileMore Marketing will include on your webpage regarding your dental savings plan. Is there any other information you would like to add?

The following questions pertain the custom brochure that will be designed for your practice.

Please check the boxes for the items you would like included in your SmileMore Dental Savings Plan brochure:

Section

[is-dentist-headshots83a2ac2dd9 show="value"]

Dentist(s) headshots

(Please only upload .jpg files.)

Dentist(s) headshots (image) *

Maximum file size: 134.22MB

Dentist(s) biography

(Please only upload .pdf , .docx, docm, dotx or dotm files.)

Dentist(s) biography (pdf, docs) *

Maximum file size: 134.22MB

Practice Logo

Office website URL

Office email address

Office email address (email) *

Social media icons

Photos of office

(Please only upload .jpg or .png files.)

Photos of office (images) *

Maximum file size: 134.22MB

Map to office

Additional information (data)

Addtional information to place on brochure.(This is in addition to information about your plan.)

Additional information *

brochure style

Brochure style preferences:

Brochure style preferences *

Bifold

Trifold

Section

You may upload your practice's existing marketing materials so our graphic design team can include similar design elements.

Marketing material

Maximum file size: 134.22MB

Thank you for providing information for our development and design teams. If you have any questions regarding this form, please email them to support@smilemore.marketing.

reCAPTCHA