Top Dentists: Client Informational Form (Dentist Profile)

Top Dentists is a special section in the March issue of Philadelphia magazine highlighting the region’s top dental experts. Your profile will consist of a photo, contact information and a Q&A. Please fill out this form completely at your earliest convenience or no later than January 11th.

IMPORTANT DEADLINES

January 11th: Please submit this form by end of day. We’ll be in touch to schedule your photo shoot.

January 14th: We’ll reach out via email with a few interview questions for your profile by end of day.

January 18th: Interview responses are due via email by end of day.

January 23rd: Expect to see a proof of your profile for your review.

January 28th: Any feedback or corrections to your profile are due. Once we get your feedback, we’ll aim to send you a new proof within 48 hours. Please make sure to gather all feedback into one, clear email as we can only make up to three rounds of changes.

February 1st: Final sign-off on your profile is due by end of day.

February 26th: The issue is on sale! Make sure to check out the Top Dentists special section to see your profile.

Contact Name:*
Contact Phone Number:*
Contact Email Address:*
Dentist name(s) for header (up to two):
Affiliate hospital or practice:*
Specialty:*
Address:*
Phone Number:*
Website URL:*
Top Dentists: Years Awarded*
Best contact for email interview:*
Please specify desired photography session date:*
MM slash DD slash YYYY
Please specify desired photography session time:*

: Hours

Minutes

AM/PM
I acknowledge that my ad includes 3 rounds of design/copy revisions and any additional revisions will incur an additional fee per revision.*
- I have read and agree to these terms above.