Name: Ultimate Assistant
Start: 2019-03-01T00:00:00-05:00
End: 2019-03-01T23:59:59-05:00

Name*
First Last
Email*
Course Name
Course Date*
Doctor Name
Practice Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Office Phone*
Cell Phone
Payment Method:
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Do you have:
- Cart System
- Laptop System
Who is primarily scanning, designing, finishing?
How long have you been using the system?
How often do you scan intra orally, impressions, models?
List what percentage of the following you are currently doing in office utilizing CAD CAM:
Crowns Inlays Implant Crowns Onlays Veneers Bridges
Are you currently doing multiple units same day?
- Yes
- No
What percentage of your CAD CAM is done :
Same Day- Same Visit- Next Day/Week-
How long is your total process for a single unit Emax restoration?
What retraction, tissue maintenance, and isolation are you currently using?
What are your primary struggles?*
What do you hope to gain from this course?*
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Signature*
Date*

Posterior Success, Mastering Onlays & Multiples Practical Advanced Anteriors

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