At Valplast, we get a large number of enquiries from patients asking us to recommend a dentist.

If you process Valplast regularly, and would like to be a part of the Dentist Referral Network, please fill out the form below.

Once a member of our team has reviewed your entry (please note that we may need to contact you to ask a few more questions), they will place you onto our Database. This will then enable your practice to be a part of the geo-targeted lists that we will then give to patients when they are asking us for local dentists. 

Address *
Address
Phone *
Phone
http://
I authorize Valplast® International Corp. to distribute this information as a part of its Dentist Referral Network *
I am aware of, and distribute the Valplast® Certificate of Authenticity to patients upon insertion of the finished partial. *
Please send marketing materials to distribute to patients. (No charge)