The Incisal Edge "Top 40 Under 40" is a program aimed at recognizing innovative and passionate young professionals in dentistry.

We are looking for the top 40 dentists in the U.S. who are under the age of 40 and are setting new benchmarks for outstanding dentistry. You may nominate more than one professional. Please complete a separate form for each nomination. Dentists are welcome to self-nominate and should feel free to nominate a colleague or peer. If nominating more than one dentist in a group practice, a form must be completed for each practitioner. Please see Q9 below.

Nominees will be judged by the Incisal Edge advisory board and the winners will be profiled in the magazine's 2018 Fall issue and online. To nominate a dentist, simply complete this form. Submissions must be completed on or before noon on Monday, March 5, 2018.

* 1. Nomination Submitted by (person completing form):

* 2. Nominee information:

* 3. Add headshot of your nominee (Optional):

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* 4. Nominee's Age:

* 5. Nominee's Specialty:

* 6. Why should this dentist be considered as one of the top in the industry? i.e. Owns multiple practices, demonstrates entrepreneurial efforts and business acumen.

* 7. What is the story behind the nominee's practice?
(i.e. Father/daughter or son, best friends since high school, husband and wife, etc.)

* 8. How did you hear about Incisal Edge? (Type N/A if not sure)

Additional Details: Please be as descriptive as possible. The following section can make or break the nomination of your candidate. The more quality information you provide to judges, the better your chance to advance in the process.

* 9. Is this dentist being nominated in conjunction with another dentist? If so, please state dentist's name and practice.

* 10. Please provide your practice website address/URL and any social networking sites for your practice (Facebook,Twitter, Instagram, LinkedIn, Google+, etc):

* 11. Nominee's educational background?
Please include names of schools attended, degrees earned, etc.

* 12. Please describe the nominee's use of clinical expertise: innovative ideas, technologies and techniques.

* 13. Does this dentist have any noteworthy passions or hobbies?

* 14. Does the nominee demonstrate involvement in local, national, international and dental communities beyond the scope of traditional give-back efforts?

* 15. Of which professional organizations is the dentist a member?

* 16. Additional information for your nominee: