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Independent RDH Practice Interest Form

Are you ready to take the leap into independent RDH practice? Fill out the form below to get connected with a mentor who can guide you through the process!

* Full Name (First and Last)

* Email Address (So we can contact you with more information and connect you with a mentor.)

Phone Number (Optional, for quicker follow-up.)

* What type of independent practice are you most interested in? (Select all that apply)

Mobile Clinic
In-Office Preventive Care
Community Outreach
Other (Please describe below)

* What area(s) of independent practice are you most passionate about? (Check all that apply)

Teeth Whitening
Preventive Services (debridements, sealants, etc.)
Oral Health Education
Other (Please describe below)

* What stage are you at in the process of starting your independent practice?

Just exploring ideas
I’ve already started planning
I’ve launched or am actively practicing

* What areas do you feel you need the most support or guidance in? (Choose up to 3 options)

Legal and regulatory requirements
Business planning and financing
Marketing and client acquisition
Networking with other independent RDHs
Other (Please describe below)

* How would you prefer to be connected with a mentor?

Email
Phone
In-person meeting (if available)

* Any additional comments or questions? (Let us know anything specific you'd like help with or any questions you have about independent practice.)

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