This form helps us collect the necessary information to create your organization’s profile on the IDC portal. Please note that if you need help with a field, instructions have been provided. If you are still having issues and/or have questions about the form, please contact Jordan Herbert at [email protected].

Basic Company Information

IDC Intake Form
Drop a file here or click to upload Choose File
Maximum upload size: 52.43MB

Contact Information

Please fill out the following fields with the person's information we should reach out to if we have additional questions or need clarification.

First Name
Last Name

IDC Profile Information

The purpose of this section is to outline how members can find you on the portal, a quick overview of your service(s), and how to contact you if interested.

Members will be able to filter by category to narrow their search
Please add keywords that describe your services (i.e. Credit Card Processing, Insurance, Supplies, Implants)
These bullet points will be the quick overview next to your logo
This will be behind a member login, so only members can view. Please outline the special offers & advantages of the partnership
If applicable, please provide a URL where our members can submit their information if they are interested in your service(s)
If you do not have a contact form and would prefer an email, we can have an email automatically sent to you with the member's information.
If you would like to link a marketing document to your profile, please upload here. If you have multiple, please send to [email protected]