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Complete the form below to send a referral email to your friend. Have your friend print the email they receive and bring it with them to their first appointment at Merit Dental. We will share our appreciation with a $20 Visa Prepaid card for both of you!

Referral (Your Friend's Information)

Office Location

Message to your Referral

Referred By (Your Information)

Program valid only in Indiana. Both rewards cards will be mailed 4-6 weeks after the new patient’s first appointment. Must be 18 years or older to participate. Current patient may refer up to one member of their household. Not valid with any other promotions such as new patient offers, or with state or federal programs. Some limitations may apply. This program is subject to change or can be discontinued at any time.

I Have Read and Understand the Program Rules and Restrictions