Mentorship Program Application

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

This program is designed for dental professionals who are ready to integrate a whole-health approach into their practice and elevate patient care.

This application will help us understand your professional background, current practice, goals, and readiness for mentorship. Dr. Sanda Moldovan personally reviews each application, and our team will contact you within one week regarding next steps.

Your information will remain confidential.

1. Professional Information

First Name *

Last Name *

City *

State *

Country *

Enter your country

Phone *

Email *

2. Professional Background

Your Practice Name *

Practice Website *

Current professional role *

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 the services you currently offer…

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? *

Which additional training topics are you interested in? *

Biological Extractions

Ceramic Dental Implants

Sleep Dentistry

Oral Microbiome

Nutrition & Systemic Health

Practice Growth & Marketing

Other areas of interest or future programs

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? (Optional) *

4. Application Acknowledgement

By submitting this application, I confirm that the information provided is accurate to the best of my knowledge and understand that submission of an application does not guarantee acceptance into the mentorship program. *

Full Name *

Date *

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