Partner Program Form - Carestream Dental

A New Portal for a New Partnership
Think you are a good fit?

Thanks to the new Partner Program Portal, potential partners can now submit their software module for consideration by filling out the form below.

Company Name*

Address*

Website

Contact First Name*

Contact Last Name*

Contact Phone*

Contact Email*

Contact Mailing Address (If Different)

Contact Fax

Contact Title*

Company Information*

Number of Dental Practice Customers*

Solution Name

Solution Summary*

Solution Description*

Solution Category*:

SIGN*

Date*

I acknowledge that I have reviewed and agree to the Privacy Statement.

I acknowledge that I have reviewed and agree to the Confidentiality Statement.