Co-Marketing Registration Form

Complete this form if you would like to be considered for AvaDent's Patient Accelerator Co-Marketing Program. Territories are limited and offered on a first-come, first-serve basis.

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Website*

Make sure you put in your full web address including the http://wwww.your domainname.com or https://www.yourdomainname.com
Email*
Cell Phone*
Type of Practice*
Do you currently have an advertising budget?*
If yes to the answer above what is the monthly ad spend*
Do you offer any of these products (check all that apply)*
- Dentures
- Partial Dentures
- Removable Dentures (implant supported)
- Fixed screw retained dentures 2 to 5 implants
How many offices do you have?*
How Many AllonX or implant supported dentures (Pre-Covid19) did you place annually?*
How do you produce your dentures & implant supported dentures?*
Would you like someone from AvaDent to contact you regarding the co-marketing program?*
What is your status with AvaDent's Partner Program?*

Click for Free One-Hour Consultation ›

Co-Marketing Registration Form

Everything dentists need to capture and convert new patients.

15730 North 83rd Way
Scottsdale, AZ 85260
United States

Tel.: Call 1-480-275-7144
Toll Free: Call 1-855-282-3368

Services

Hybrid Product Offering

ABOUT US

Click for Free One-Hour Consultation ›

Co-Marketing Registration Form

Everything dentists need to capture and convert new patients.

15730 North 83rd WayScottsdale, AZ 85260United StatesTel.: Call 1-480-275-7144Toll Free: Call 1-855-282-3368

Services

Hybrid Product Offering

ABOUT US

15730 North 83rd Way
Scottsdale, AZ 85260
United States

Tel.: Call 1-480-275-7144
Toll Free: Call 1-855-282-3368