Apply Now - Front Office Academy

WELCOME!

Accelerate your dental knowledge through hours of online videos and documents on how to implement systems to be more efficient and achieve success.

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Name*

First Last

Password*

Enter Password Confirm Password

FOA Membership

Preferred Email Address*

(Your Future Login if Accepted)*

Cell Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Clinic Name*

Simply part of the vetting process (even if not an owner, we want to learn about where you work)

Dental License Number

Enter your dental license if you are the applicant. Please DO NOT enter a dental license number if you are not a Dentist.

Job Title*

Are you a member of AGD?*

AGD Number

Please enter your AGD number.

Do you own multiple practices?*

If yes, please list them here.*

Are you the main point of contact for your practice(s)?*

If "No," please provide the main point of contact's information below.

First and Last Name*

Email*

Position Title*

How did you hear about us?*

What is their name?*

We would love to give them a free month for "Sharing the Love"!

If other, tell us how!*

Finally, you understand that there is a fee of $179 due at the time of scheduling.*

Credit Card*