Intro / Instructions
Thank you for starting your C3 Dental Marketing Visibility Listing. This short onboarding form collects the approved business details and marketing assets needed to build your listing, animated billboard media, and state-network placement. Please do not submit patient health information, private patient details, login credentials, or patient images unless documented authorization exists and C3 has separately agreed in writing.
Business & Contact Information
Dental Practice Name
*
Primary Contact Name
*
First Name
Last Name
Best Email Address
*
example@example.com
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Practice Website URL
*
Public Office Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Office Address
*
State Network Selected
*
Please Select
Select State Network A
Select State Network B
Select State Network C
Other
Package & Listing Preferences
Package Purchased
*
Please Select
Standard Visibility Listing
Pro Visibility Listing
Premium Page 1 Featured Visibility Listing
New Patient Status
*
Please Select
Now accepting new patients
Limited availability
Not accepting new patients
Contact office to verify
Insurance Listing Preference
*
Please Select
Mention accepts many major plans/call to verify
Do not mention insurance
Contact us before publishing insurance language
Preferred Call to Action
*
Visit Website
Call Office
Request Appointment
Get Directions
Learn More
Dental Services to Highlight
*
General Dentistry
Family Dentistry
Cosmetic Dentistry
Dental Implants
Emergency Dentistry
Orthodontics
Pediatric Dentistry
Oral & Maxillofacial Surgery
Periodontics
Endodontics
Prosthodontics
Teeth Whitening
Clear Aligners
Dentures
Other
Primary Service or Offer to Feature
*
Short Practice Description
*
What Makes the Practice Different
*
Uploads & Online Profiles
Upload Practice Logo
*
Upload a File
Drag and drop files here
Choose a file
Upload only logos, office photos, team photos, or marketing images your practice has permission to use. Do not upload patient images unless your practice has documented authorization and C3 has separately agreed in writing.
Cancel
of
Upload Approved Office Images
Upload a File
Drag and drop files here
Choose a file
Upload only logos, office photos, team photos, or marketing images your practice has permission to use. Do not upload patient images unless your practice has documented authorization and C3 has separately agreed in writing.
Cancel
of
Office Hours
Office Hours
Example: Monday–Thursday 8am–5pm, Friday 8am–1pm, Saturday/Sunday closed.
Additional Notes
Approval
*
I confirm that the business information and assets submitted are accurate, approved for C3 Dental Marketing to use, and may be used to create, publish, host, embed, and promote my Visibility Listing, animated billboard-style media, C3 state-network placement, and related social media promotion. I understand that C3 does not guarantee leads, patients, rankings, or revenue. I will not submit patient health information, private patient data, login credentials, or unauthorized patient images through this form.
Social & Online Profile Links
Optional: paste any approved public business profile links such as Facebook, Instagram, LinkedIn, YouTube, TikTok, Google Business Profile, or other public profiles. Do not provide passwords, login credentials, private account access, patient information, or private patient images.
Submit
Should be Empty: