Contact Form Owner Login

Your Full Name(Required)

The Name of Your Practice(Required)

Your Email(Required)

Your Work Phone(Required)

Your Cell Phone(Required)

Your Back Office Line and Fax

What dental university did you graduate from?(Required)

How many years have you been practicing?(Required)

How many dental practices do you own?(Required)

How many practices have you owned in the past?(Required)

How many practices did you work at before becoming an owner?(Required)

What dental services do you currently offer your patients?(Required)

Last 3 years of annual production /collection? (If you own more than one practice please provide production /collection for each one separately)(Required)

What do you want to achieve from this training Treatment Plan Tracker System®?(Required)

What training have you had in Case Presentation and by who? When?

Do you work closely with your Treatment Coordinator? Please explain.

What areas of your practice do you feel could be improved?(Required)

What do you dislike the most about being an owner?(Required)

What do you enjoy the most about being an owner?(Required)

What do you dislike the most about being a doctor?(Required)

What do you enjoy the most about being a doctor?(Required)

What do you dislike about your profession?(Required)

What do you enjoy about your profession?(Required)

Is there anything you want me to know about your practice or your goals prior to coming to implement the Treatment Plan Tracker System®? Please explain.(Required)

Thank you for taking the time to fill out this from. As you know I will interview your key staff prior to coming to your practice in preparation for the training and implementation. My executive assistant will set up a final time for us to talk so I can share with you the feedback from your staff and anything I find which may be helpful or vital.