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Diamond Club Makers Application

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Please answer all in full.

This will be used to tell if I can help you. It is important to me that I can really help you.

Name*
Are you on WhatsApp yet?*

Practice Information

Do you have any affiliation with a DSO/Corporate Partner or other corporate entity besides your non-corporate office?*
Are you in negotiations or considering any affiliation with a DSO/Corporate Partner?*
Practice Location*
Last three years total practice collection numbers?*
Last Year
Two Years Ago
Three Years Ago
Last three months Invisalign case start listed per months?*
Previous Month
Two Months Ago
Three Months Ago
Clincheck numberMaximum of 3. Find your Clincheck ID # on the Invisalign Doctor Website (which can be accessed from your phone at this link) Then press ‘Account’ ‘Payments’ and you will see you ID# which is shown in pink highlighter. Visit Invisalign Doctor site.
Are you or about to be an instructor/teacher/coach/mentor for any dental organizations/companies/groups or similar?*
Align Rep Name*
Current or Past DCMer Name*
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The next class is being planned for December of 2022 or January of 2023. We are currently accepting applicants for the waiting list. Upon submitting this application, you will be charged a $1 non-refundable fee. If you are accepted to the class you will be asked to complete the full payment of $9,479.
Price: One Dollar
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