Loyal Patients, Inc.™



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Refer A Colleague

Do you know a colleague that could benefit from Loyal Patient™ Rewards?

Thanks for your interest in sharing information about Loyal Patient™ Rewards with your colleagues.

As you know, Loyal Patient™ Rewards is a completely non-competitive program. Because we focus only on internal marketing and rewarding your own current patient base, it is non-competitive with other dentists in your own community, or even with dentists in your own medical building.

Many dentists are already referring their colleagues to us. When you refer a colleague who enrolls in our program, we’ll send you a valuable free gift to express our thanks. ref

Here’s how to refer a colleague:

1. Provide Your Information:

First Name:	* ^{= Required Fields}
Last Name:	*
Title:
Office Name:
Address:
Address:
City / State / Zip:
Office Phone:	*
Mobile Phone:
Email:	*

2. Complete the form for each Colleague:

Colleague 1

First Name:

* ^{= Required Fields}

Last Name:

Title:

Office Name:

Address:

City / State / Zip:

Office Phone:

Mobile Phone:

Email:

Colleague 2

First Name:

* ^{= Required Fields}

Last Name:

Title:

Office Name:

Address:

City / State / Zip:

Office Phone:

Mobile Phone:

Email:

Colleague 3

First Name:

* ^{= Required Fields}

Last Name:

Title:

Office Name:

Address:

City / State / Zip:

Office Phone:

Mobile Phone:

Email:

Colleague 4

First Name:

* ^{= Required Fields}

Last Name:

Title:

Office Name:

Address:

City / State / Zip:

Office Phone:

Mobile Phone:

Email:

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What Dentists Are Saying...

"I think this will work in my practice very well. My practice is internal marketing oriented."

Bryan L. Grimmer, DDS

What Patients Are Saying...

"Wow! We get enough rewards this month to get huge savings on a new digital camera? This is a great program! "

Pamela J

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