Podcast Guest Application
Before we have you as a guest on our podcast, we'd like to collect some information from you first. All applications submitted to us are subject for our approval. We will get in touch with you if we are interested in having you on our show!

Please fill out the following application before you join us on our podcast.

Direct all inquiries to info@dentistsimplantsandworms.com

Name *
Please include your full name along with any credentials (i.e. DDS, DMD, MBA, etc.) you want notated.
Your answer
Phonetic Spelling of Name (optional)
Sometimes we are stupid and mispronounce names. If you have an uncommon name that requires extra attention to pronunciation, please specify below. If you have a name that your average worm could spell, don't worry about filling this out.
Your answer
Skype Username *
We record all of our in-studio podcasts via Skype. We only record the audio portion of the podcast; however, we will use both audio and video for the interview itself— it's just more comfortable being able to see one another! Don't have Skype? No problem! You can download Skype and create a free account by visiting http://www.skype.com
Your answer
Phone Number *
This is strictly used so we can get in touch with you immediately if we run into any issues connecting with you on Skype. We will not give out your e-mail address and phone number in our show notes, unless you specifically ask us to.
Your answer
Email *
We will not give out your e-mail address and phone number in our show notes, unless you specifically ask us to.
Your answer
Mailing Address (optional)
We'd love to mail you a little token of our appreciation for being a guest on our show! Please include the city, state and zip code. This is entirely optional and will not be shared if collected.
Your answer
May we share your contact information in our show notes? *
Website(s) *
We want to plug your practice, business venture, personal website, etc. as much as possible. Let us know what we can plug for you! All websites that are listed below will be included in the show notes and mentioned on the podcast.
Your answer
What is your alma mater? *
We're interested in hearing about our guests' educational background. Please include what year you graduated.
Your answer
What is the name of your current company, practice or school? *
Your answer
Topics to Discuss on the Podcast *
Please include five or more topics you would like to discuss with us on the podcast.
Your answer
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