Med-Connect On Boarding Form

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Med-Connect On-Boarding Form

Practice Information

Please type your practice name.
Please type the full name of the principal dentist.
Please type in your practice marketing contact & phone number.
Please type in your suburb.
Please choose an option

Marketing Information

Please type who you think is your target audience. E.G. Young patients, elderly patients, children, etc

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Visual Assets

For your digital marketing to be a success, it's vital that you not only share your photos, logos, team and cases with us as we onboard, but that you send us updates at the end of each month, for the month ahead

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Terms & Conditions

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Please check the box to confirm you agree to our t's & c's