Associate Search Submission Request
Please fill out the information below after you have signed an Associate Agreement. For any questions, please email molly@udba.biz.
Full Name
First Name
Last 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.
Select Type of Dentist needed:
General Dentist
General/Pediatric Dentist
Periodontist
Endodontist
Other
Name of Practice
Needed
Full Time
Full Time or Part Time
Part Time
Benefits:
Mentorship Available
CE Allowance
Tuition Reimbursement
Pathway to Ownership
Guaranteed Salary
Bonus
Please list any additional employment benefits provided:
Proposed Employment Start Date:
Address of Employment Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Any additional notes for marketing purposes about your practice?
Upload any pertinent or desired materials.
Browse Files
Drag and drop files here
Choose a file
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of
Best form of contact:
Work Email
Private Email
Work Phone
Cell Phone
What would you like the marketed location to be for your available associate position?
Submit Form
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