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Tell us about your practice!
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Practice Name:
Practice Address:
Nearby Landmarks:
Name of Doctor(s):
Years of experience in full arch dentistry:
Education and Training:
Name of main point of contact:
POINT OF CONTACTS EMAIL ADDRESS:
Point of contact direct phone number/cell:
How long is a typical consultation appointment?
30 mins
1 Hour
Other
How many appointments can we book for a single time slot?
One
Two
Other
Do you offer virtual consultations?
Yes
No
If yes, what do you require for virtual consultations?
Which languages are the consultations provided in?
Which treatment(s) are offered?
What are each of your treatment prices?
Are you providing bone grafting?
Yes
No
What is your insurance policy for All-on-4 implants?
Which system/brand of implants are being used?
What is your typical treatment timeline? When are you delivering temps? Finals?
What are your sedation offerings?
Oral sedation
Nitrous oxide
Local Anesthetic
IV sedation
Other
Accepted insurance(s):
What are your current financing options for your patients?
How would you prefer items such as financing options, insurance details, and monthly payment plans are communicated with your patients?
Is there any additional information you’d like to share about your practice?
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