Send Us Smiles

Photo Submission Form

"*" indicates required fields

Your Name
Doctor's Name*
Check the box if this doctor is also a board member
Patient's Name*
Max. file size: 50 MB.
Max. file size: 50 MB.
Max. file size: 50 MB.
Please provide any back ground or story information from either the patient or doctor or other associated person.
Max. file size: 50 MB.
You can find this on the last page of the patient application. Please provide this if it is signed.
/*! elementor - v3.7.1 - 14-08-2022 */ .elementor-widget-image{text-align:center}.elementor-widget-image a{display:inline-block}.elementor-widget-image a img[src$=".svg"]{width:48px}.elementor-widget-image img{vertical-align:middle;display:inline-block}
/*! elementor - v3.7.1 - 14-08-2022 */ .elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#818a91;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#818a91;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}

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Contact

Dental Lifeline Network
1800 15th Street, Suite 100
Denver, CO 80202

Phone: 303.534.5360
Fax: 303.534.5290

Apart from the free survey software, we also have access to QuestionPro’s free survey templates . We’ve found many of them useful and powerful to collect insights from various stakeholders of our organization.

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