Apply to be a IL Top Doctor or IL Top Dentist

By clicking below and submitting this application, I certify that all the information above is true to the best of my knowledge and held to be true. I also understand and agree that IL Top Docs (a division of USA Top Docs) may in their sole discretion, to approve or deny my application with or without cause. I understand and agree that IL Top Docs will conduct a background check (free of charge to myself) to review my license, malpractice, education, training, and employment. I also acknowledge that by providing my fax number and/or email addresses on this form I am giving USA Top Docs, permission to use this information in perpetuity and from time to time send marketing related information via fax and/or email. I also acknowledge an ongoing business relationship with USA Top Docs. I understand that my information will never be sold or distributed to anyone outside of USA Top Docs. If I wish to be removed from USA Top Docs (or its subsidiaries) communication, I must submit the request in writing to [email protected], via fax to 908-288-7241 or via phone message by calling 908-288-7240 x 100 24/7/365. For this request to be valid (i) the request must clearly identify the fax number(s) to which this request relates too and (ii) the request must be communicated by one of the methods listed above.