Mentorship Program Application

Thank you for your interest in the Integrative Dental Health Institute Mentorship Program.

I truly appreciate your interest in working with me and the trust you are placing in this mentorship journey.

I personally review every application and look forward to learning more about you, your practice, and the goals you hope to achieve. It is an honor to support dedicated dental professionals who are committed to advancing their knowledge, elevating patient care, and creating a meaningful impact through integrative dentistry.

You can expect to hear from our team within one week regarding next steps.

Your application and information will be treated with care and kept confidential.

In great health,
Dr. Sanda Moldovan

1. Professional Information

First Name *

Last Name *

City *

State *

Country *

Enter your country

Phone *

Email *

Your Practice Name *

Practice Website *

Are you a decision-maker in your practice? *

Yes

No

If no, please tell us a little about why you are interested in the mentorship at this time and what you hope to gain from the experience.

2. Professional Background

Your Current Professional Role (Please select all that apply.) *

General Dentist

Periodontist

Pedodontist

Prosthodontist

Oral Surgeon

Endodontist

Orthodontist

Dental Hygienist

Dental Assistant

Dental Student

Dental Practice Owner

Other

Please specify your professional role if you selected “Other” above.

Your License Type *

Years in Practice *

Where do you currently practice? *

Do you currently offer any biological, holistic, or integrative dental services? *

Yes

No

If yes, please list them here.

3. Mentorship Goals

What are the top 1–3 outcomes you would like to achieve through this mentorship? *

What is currently preventing you from achieving these goals on your own? *

How much time can you realistically commit each week to learning, implementing new protocols, and applying what you learn in your practice? *

Less than 2 hour per week

3–4 hours per week

5–7 hours per week

8+ hours per week

Is there anything else you'd like us to know about you or your practice?

Privacy Policy | Terms of Service

Transforming Dentistry to Restore Health — Not Just Teeth

© 2026 Integrative Dental Health Institute · integrativedentalhealthinstitute.com Privacy Policy Terms of Service