Name: Posterior Success, Mastering Onlays & Multiples
Start: 2019-05-04T00:00:00+00:00
End: 2019-05-05T23:59:59+00:00

Name
First Last
Email*
Course Name*
Course Date*

Pick Date From Calendar
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
How long have you had the system?*
What CAD CAM courses have you taken?*
What percentage of the time are you scanning :
Same Day- Same Visit_ Next Day/Week-
Are you currently placing implants?*
- Yes
- No
What percentage are you currently doing :
Implants Bridges
How many of those do you utilize CAD CAM?*
Are you presently sending cases to a lab using DDX?*
- Yes
- No
If so what lab are you using?
What is your total appointment time for a single unit Emax restoration done same day?
What retraction, tissue maintenance, and isolation are you currently using?
What are your primary struggles?*
What do you want to achieve with this course?*
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Signature*
Date*

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