TOP DENTISTS SUBMISSION FORM

Please complete this form for your profile and/or enhanced listing to appear in the Top Dentists section in the April 2026 issue. Submission deadline is February 20, 2026.

Dentist Name
*Please give us the name you'd like to be published with your enhanced or photo listing
Name of dental practice
*Please give us the name you’d like to be published in your profile.
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
*Please give us the full street address you’d like to be published in your enhanced listing.
Phone
*Please give us the contact information you’d like to be published in your profile.
Website

*Please give us the contact information you’d like to be published in your profile.
Profile Text
*Please provide 75 words for a quarter-page profile, 100 words for a half-page profile, 125 words for a full-page profile, or 150 words for a full page-spread profile. Profiles will be edited for length, as well as tone/style. No logos will be included with profiles.
Enhanced Listing With Photo ONLY
Accepted file types: jpg, jpeg, Max. file size: 512 MB.
Please upload your headshot if you have purchased an Enhanced Listing With Photo
Contact
*Please provide the name and e-mail address for the person we should contact with questions about your profile.
Contact Name*
First Last
Contact Email*