The Hygienist Collective Sign-up Thank you for joining the Hygienist Collective. We are excited about the opportunity to let your voice be heard. Participation is completely anonymous, and each study will allow you to earn rewards. The Hygienist Collective Signup Full Name (As shown on License) * Phone * Email * Title Please Select OneHygienistDental AssistantOffice Manager The Hygienist Collective requires the verification of your license number to help maintain the integrity of our panel. Hygienist License Number * Expiration Date * State Licensed In * Your license number will not be shared. Privacy policy. Shipping Address * City * State * Zipcode * Dental Office Name * Number of years in practice * Do you work Part-Time or Full-Time (4 or more days per week)? Please Select OnePart-TimeFull-Time What type of practice do you work in? Please Select OneGeneral Dentist PracticePeriodontistPediatric Dental OfficeOther (Please Specify) Which of the following best describes your practice? Please Select OnePrivate PracticeCorporately Owned, or Dental Service OrganizationPublic Health Which of the following best describes your involvement related to new hygiene related products in your office? Please Select OneI have the authority to purchase items I wantI am the lead clinical advisor on a team of people that make the decisionI am involved in the decision along with a group of othersI provide input, but am not part of the decision processNo involvement at all What type of opportunities interest you? (Select all that apply) * Focus Groups Surveys New Product Testing Webinar Opportunities What other types of opportunities interest you? How comfortable are you in using online meeting platforms such as Zoom/Teams/Google Meet? Please Select OneVery ComfortableComfortableNeither Comfortable or UncomfortableUncomfortableVery Uncomfortable Gender Please Select OneFemaleMalePrefer not to say I have read the terms and conditions. * Yes If you are human, leave this field blank. Submit Δ
