Unitas Landing Page Contact Form

For more information or to book a call, fill out the form below!

Vendor

Lead Status

Source

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Name*

First NameLast Name

Email*

example@example.com

Office Number *

State*

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Preferred Contact Number

Practice Name *

Practice Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Approximately how many PPO Insurance contracts are you currently participating in?

What kind of Dental Practice are you?

How many locations do you have?

How many full-time and part-time Dentists practice at your location(s)

What are you interested in learning more about on our call? (Select all that apply)

PPO NegotiationsAdding PPO PlansStarting a New Dental PracticeIn-House Discount Plan