Dental Assisting Academy of Broward

Program interest form

Your information

First name *

Last name *

Email address *

Phone number *

Programs of interest — select all that apply

Registered Dental Assistant with Expanded Duties and Dental Radiology

Board approved

Dental Administrative Assistant Program

Administrative

Choose one or more tracks

Dental Receptionist / Front Desk

Treatment and Scheduling Coordinator

Insurance and Billing Coordinator

Questions or comments (optional)

Confidentiality of your information

The personal information you provide through this form is collected solely for the purpose of responding to your program inquiry. It is treated as strictly confidential, will not be shared with, sold to, or disclosed to any third party under any circumstances, and will be used exclusively by the Dental Assisting Academy of Broward to communicate with you.

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Your inquiry has been received. A member of our team will contact you soon.