Registration Step 2 - Journey Dental Group

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Practice Details

City*

State*

Number of Practices*

Total Number of Doctors in Your Practice(s)*

YTD Collections*

YTD Expenses*

Additional Profit Multipliers

(These can greatly impact your valuation)

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Total Number of Associate Doctors*

Do you own your office location?*

Number of Hygienists*

Number of Operatories*

Will Your Spouse/Partner be Joining You?*

Yes

Partner/Spouse First Name*

Partner/Spouse Last Name*

Partner/Spouse Email*

Will Your Staff be Joining You?*

Yes

Staff Product *

Price: $99.00

Please enter all information for your staff below. Please note that a unique email must be provided for each person in your party. Failure to enter this information will result in an error. If you have any questions about the form, please email team@iaos.com

Staff Registration

First Name

Last Name

Position

Your Email Address*

Billing Address*

Street Address Address Line 2 City State ZIP Code

Doctor Ticket

SMS Contest*

I agree to Journey Dental Group’ Terms of Use and Privacy Policy. I consent to receive calls and SMS updates from IAOS about my business. Message frequency may vary; message and data rates may apply. Reply STOP to opt-out, HELP for more info.

Coupon

Total

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

CAPTCHA

Secure Your Dental PayDay Tickets

Please complete the form below & reserve your spots today! Seats are going fast!

Practice Details

Additional Profit Multipliers

(These can greatly impact your valuation)