Associate Search Submission Request

Associate Search Submission Request

Please fill out the information below after you have signed an Associate Agreement. For any questions, please email michelle@udba.biz.
Full Name

First NameLast Name
Practice E-mail
example@example.com
Personal Email if desired
example@example.com
Work Phone Number
Please enter a valid phone number.
Personal/Cell Phone Number if desired
Please enter a valid phone number.
Name of Practice
Practice Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Select Type of Dentist needed:

General DentistGeneral/Pediatric DentistPeriodontistEndodontistOther
Needed

Full TimeFull Time or Part TimePart Time
Benefits:

Mentorship AvailableCE AllowanceTuition ReimbursementPathway to OwnershipGuaranteed SalaryBonusRelocation Assistance401(k) w matchHealth / Dental / Vision InsurancePaid time off
Share additional benefits:
Practice Highlights

Fee For ServiceBusy officeFriendly officeEfficient officeState-of-the-art technologySupportive teamEstablished teamReferral basedPrivately ownedCorporate ownedMulti-location practicePaperlessSingle-location practice
Annual collections
Financial model
New patients per month
Type of technology your practice features
(Digital C-rays, X-Nav, etc.)
Share additional practice highlights:
Community & Lifestyle

Great school districtsReasonable cost-of-living in the areaWonderful area for familiesExcellent Quality of LifeGreat arts and culture sceneVibrant nightlifeClose to the beachWonderful hiking and outdoor opportunities nearCollege townCity/Town with little to no commute or trafficPublic transportationAffluent communityMetropolitan locationSuburban location
Share any additional notes for marketing:
Proposed Employment Start Date: (immediately or certain target start date)
Address of Employment Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload any pertinent or desired materials.

Cancelof
Best form of contact:

Work EmailPrivate EmailWork PhoneCell Phone
What would you like the marketed location to be for your available associate position? (i.e. Is this position confidential?)
How did you hear about UDBA
Should be Empty: