New Clinic Sign Up Form

Thank you for your interest in opening a Smile & Co account. We are thrilled to work with local clinics by providing a streamlined way to hire temporary and permanent staff. Please use the form below to get started, once we have received your application we will contact you to complete the account setup and answer any questions you may have.

Payment: There is a payment section on the bottom of this form which is required upon signup. You will be billed $49.00 which will be applied to your first booking. This allows us to verify accounts and capture your billing information for future payments. We do not store any payment information or have access to it, this is done through our payment provider Stripe.

Your Information


Employment Information


Agreement


Sign Here

Billing Information


Price: $49.00
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