Become a Member or Learn More

If you are ready to join OR have questions about Mari's List, please submit the form below and we will be in touch. We speak to each member personally prior to signup!

Doctor Name*

First NameLast Name

Doctor Email*

This information is kept private and is available only to Mari and her direct team.

Doctor Mobile*

This information is kept private and is available only to Mari and her direct team.

Name of Practice*

Main Office Phone*

Please enter a valid phone number.

Main Office Address*

Street Address

Street Address Line 2

CityState

Zip Code

Ordering Staff Email*

Bracket Supplier*

Number of Doctors in Practice*

Number of Office Locations*

Is your office a start-up?*

NoYes

We define a start-up as a brand new office starting from the ground up; not a purchased existing office.

How can we help?*

I am ready to join! Please send me the membership agreement.I have questions. Please contact me to discuss.

Best way to contact you?*

EmailCallText

Best time to call?*

How did you hear about us?