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Dental Placement Services - Employers

This is a Dental Placement Service only.

Please fill out the form below if you are looking to hire a dentist.

Employer Sign Up

Full Name:

Cell Phone:

Office Phone:

Home Phone:

Address:

Address Type:

Home

Office

Which is the best way for dentists to contact you for an interview?

Home

Office

Cell

Email

What days of the week are you needing dentists to work?

Mon

Tues

Wed

Thur

Fri

Sat

Sun

Flexible Days

What is the pay scale for the new dentists?

What types of insurance do you accept? HMO, PPO, FFS, Other (out of 100%)

HMO:

PPO

FFS

Other: (Medicaid, etc)

Do you accept Medicaid?

Yes

No

What type(s) of dentist(s) do you have need for? (Click all that apply)

Generalist

Specialist - Oral Surgeon

Specialist - Ortho

Specialist - Pedo

Specialist - Prostho

Specialist - Perio

Expected Hire Date:

Are you interested in hiring Full-/Part-time?

Full-time

Part-time

Temporary

Any of the Above

Are you interested in an associateship or buy-out?

Associateship

Buy-in/out

Either

How can I send you the associate placement agreement?

Email

Mail

Is this placement confidential?

Yes

No

*If yes, what is the name of the doctor you do not want to know or staff?

Please describe the opportunity.

Disclosure

** The above information will not be distributed to third parties and personal information will NEVER be displayed on website. Any contact info will be given privately. **

THIS IS ASSOCIATE PLACEMENT ONLY! There is no broker's fee or Buy-In/Out Services

By checking, I agree to this statement.

AGREEMENT

Your Full Name Below Constitutes your Signature.

DISCLAIMER: Any referral cannot be used by any individual, practice or organization in regard to placement whatsoever, more particularly sue owner personally or Smile Placement.com for any placement. Every individual, entity or organization should seek competent legal advice.

I agree to all of the above

I agree to all of the above

Today's Date:

Signature

Thank you for contacting us.
We will get back to you as soon as possible.

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Contact Us

Phone: 561-262-5429

Email: Sandy@SmilePlacement.com

Office Hours:

By Phone:
Monday-Thursday: 6:00pm-7:30pm

Saturday: 10:00am - 1:00pm Eastern

Email: 24/7

Location:

6256 Foster St, Jupiter FL 33458, United States

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