Partner Clinic Programme

Expression of Interest

Complete this form to be considered for the DentAItinerary partner clinic network. Our team reviews every application and follows up on WhatsApp within 48 hours. This form does not constitute a binding agreement.

1Clinic Details

Clinic / Practice Name *

Year Established

Full Address

City *

Provide at least one — website or Google profile *

Website

Google Profile URL

2Primary Contact

Doctor / Owner Name *

Designation

WhatsApp Number *

Email Address

3Clinical Capabilities— tick all that apply

Single Implants

All-on-4 / All-on-6

Full Mouth Rehabilitation

Veneers

Crowns & Bridges

Root Canal Treatment

Orthodontics / Aligners

Teeth Whitening

4International Experience

No prior experience

1–5 patients / year

5–20 patients / year

20+ patients / year

5Languages at Clinic

English

Hindi

Punjabi

6Accreditations / Certifications— if any

7What are you hoping to achieve through this partnership?

8Preferred Follow-up

WhatsApp call

In-person visit

Video call

Preferred time / day

By submitting this form, I confirm that the information provided is accurate and that I wish to be considered for inclusion in the DentAItinerary partner clinic network. This Expression of Interest does not constitute a binding agreement — a formal clinic agreement will follow upon network acceptance.