Free Dental Assistant Inquiry Form

Free 16-week Dental Assistant Training Program

711 E Lamar Blvd Suite 215, Arlington, Texas 76011
Name*

First NameLast Name
E-mail*
info@dentalgeniustraining.com
Phone Number*
Format: (000) 000-0000.
How old are you? (age)*
Do you have reliable transportation?*
What county do you reside in?*

Other
Do you have a GED or high school Diploma? *
Have you ever been convicted of any crime? If yes, explain*
Have you have a college degree? (Associates, Bachelors, Master's.)*
Do you have valid state ID & social security card? These are required at the time of enrollment.*
What training session are you interested in? (Classes are held every Monday, Wednesday, and Friday)*
Are you interested in sitting in a live class to see if Dental Genius is right for you? This is totally optional and doesn't effect you in any way from receiving free training.
Have questions regarding the program? Text "Free Dental School" to (817) 899-4410 and our program administor will reach out to you promptly.
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Free 16-week Dental Assistant Training Program