Message To Our Dentists

Our services to you and our dental practice clients are the result of significant time and money spent for recruiting great dental talent, building relationships in the dental community, and tirelessly coordinating interviews and placements to keep you working and our practices productive. In order to protect our investment in this process and our business, our dental practice clients sign a contract in which they agree not to directly hire or procure the services of a dentist we have referred to them, without going through Dental Power / Dentist Placement Advantage ("Dental Power"). We feel it is important that you understand this contractual relationship.

In addition, during our professional relationship, we will be working hard and relying on each other to coordinate work assignments and/or identify appropriate opportunities for you. In order for us to work together, we ask that you agree with these simple, but important conditions:

1. You will keep our office immediately informed regarding any phone conversations, interviews/working interviews, and job or work offers made by a dentist or dental practice we refer you to, which we do not directly coordinate with you.

2. All opportunities we discuss with you are to be kept strictly confidential -- please do NOT ever share information on specific opportunities with colleagues or others in the dental community.

3. If a dentist or dental practice we have referred you to should ever ask you to work for them without informing or going through Dental Power, or refers you to another related office or practice, you will either inform us of the situation or ask them to please call Dental Power to coordinate the assignment or position. Keep in mind that if a doctor asks you not to inform Dental Power of a future working relationship with them, they are challenging your integrity, as well as violating their agreement with Dental Power, and they are most likely not someone with whom you would want to create a long-term relationship.

We appreciate your understanding and willingness to accept these terms, and look forward to a long, productive professional relationship.

Please check "Yes" or "No" to the representation questions below. If the answer to any of the following questions is "Yes", then please supply a detailed explanation in the provided field.

YesNoRepresentation Question
1. Has your license to practice dentistry or prescribe controlled substances in any jurisdiction ever been revoked, suspended, denied or voluntarily suspended, or is any such action or other disciplinary or misconduct action pending or withdrawn?
2. Has your membership in any medical organization ever been suspended, revoked, limited or denied, or is any such action pending or withdrawn?
3. Are there any pending administrative agency or court cases, or administrative agency or court decisions, judgment or settlements in which you are alleged to have violated, or was found guilty of violating any criminal law? (Exclude minor traffic violations)
4. Have any professional liability lawsuits ever been initiated against you?
5. Has any judgment or settlement been made against you in any professional liability case or is any case pending?
6. Are there any prior or pending government agency or third party payer proceedings or litigation challenging your treatment, charging, collection or utilization practices, including but not limited to Medicare/Medicaid fraud and abuse proceedings and convictions?
Explanations (if applicable):

Please fill-in the below information to certify that the information provided above is accurate and true, and to indicate that you have read, understand and agree with our message:
Dentist Full Name Enter Name
Email Address (or phone) Enter Email/Phone#
Identification (enter dental license # & state OR birth date if awaiting licensure) Enter ID Information

PRIVACY POLICY: Dental Power collects certain personal information to help verify the identity of the dental professional candidates we represent. Dental Power does not rent, sell, or share personal information about you with other people or nonaffiliated companies except in providing placement services to our clients, when we have your permission.

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