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45 Day Free Trial (Start-Up Manual)

Thank you for purchasing the Dental Start-Up Manual!

Fill out the form below to claim your 45 day DSN free trial!

Name*
First Last
Preferred DSN Email Address*
(Your Future Login if Accepted)*
Password*
Enter Password Confirm Password

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Cell Phone Number*
Please provide the best cell number to receive the most up-to-date news and announcements. We will never spam you or share your info with anyone.
Office Number
Do you reside in the United States?*
- Yes, I reside in the U.S.
- No, I reside outside the U.S.
Address*
Street Address Address Line 2 City State ZIP Code
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
When would be a good time to contact you?*
Clinic Name*
Simply part of the vetting process (even if not an owner, we want to learn about where you work)
How many clinics are you an owner in, if any?*
If an Associate, enter 0.
Please enter a number from 0 to 99.
Dental License Number*
AGD Number*
Are you a member of the AGD? If so, please provide AGD number for online CE submission.
GST/HST Number
If your practice is registered for GST/HST with the Canada Revenue Agency, please enter your GST/HST number. Leave blank if not applicable.
Annual Revenue*
DSN Members and faculty openly share information because this is a place of empowerment. Privacy is respected and valued.*
As part of this community, you will gain access to clinical and business secrets & battle-tested insights of industry leading experts. Do you agree to keep this information confidential?*
- Yes
- No
DSN members check our egos at the door. We share our challenges openly and humbly so as to shortcut the feedback process and get the answers we need. Same team: dentists! Watch what WE can build.*
Do you agree to contribute to the community by sharing your challenges and successes so we can all learn from each other?
- Yes
- No
Our intentions are pure...We accept ZERO vendor kickbacks! All the savings go to you (avg. 10-55%). This is unprecedented and vendors are shocked to hear this.*
If you are accepted, you enter a 45-Day vetting period, to ensure fit. After this vetting period you will have access to BIG discounts, to our trusted vendors, to our CE, and to a few other surprises. Can we trust you to not share your access to these benefits with non-members?*
- Yes
- No
DSN provides our partners with a list of our members and contact information so you don’t miss a beat in savings with suppliers you may already be using!*
We understand and value our member's privacy. If sharing your office information with our partners is something you would like to opt-out of, we get it! Simply click "Do not share my information".
- Yes, share my information with DSN vendors
- No, do not share my information with DSN vendors
What part of the Dental Success Network are you most interested in?*
- Savings & Vendor Discounts
- Team Training
- Continued Education
- Startup & Acquisition
- Growing My Practice
What three challenges can we help you solve?*
*Please Select Three
- Systemization Implementation
- Team Culture
- Become a Better Leader
- Understanding Cash Flow
- Inventory & Overhead Control
- Understanding My Business
Shirt Size*
- Extra Small
- Small
- Medium
- Large
- Extra Large
Were you referred to DSN by an existing member?*
Enter first and last name of the referring member*
DSN Membership
Finally, you understand that, if accepted, there is a monthly membership fee of $199 per month once your 30 day free trial expires*
This is a NO CONTRACT, CANCEL ANYTIME approach because we want you in Position #1...finally. Why pay? Communities that pay, pay attention. This ensure we have a high-quality group of Members and that we can pay our EXPERTS and the most influential people in dentistry paid to pay attention to YOU!*
- Yes
Credit Card
Card Details
Cardholder Name

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(928) 968-3505

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support@dentalsuccessnetwork.com

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