Please tell us how to contact you...

First Name *

Last Name *

Phone Number *

How did you hear about us? *

Email Address *

Confirm Email Address *

Practice Name: *

Street Address *

Suite Number

City *

State *

Zip/Postal Code *

Your Info in exchange for Free Patient Education software :)

Type of business *

How many offices do you have? *

Do you own a scanner *

Types of procedures you offer (select all) *

Dentures

Overdentures

Fixed Dentures

Do you have a CBCT in your office? *

YES

NO

NO, but I have room for one.

Est. number of dentures, overdentures or hybrids you make each month? *

Do you place and restore dental implants? *

YES, I place and restore implants

NO, a specialist does this for me

Do you have chairtime for more procedures? *

YES

NO

Would you be interested in adding $500K to $1M in Net Free Cashflow to your practice? *

YES

NO

I'm interested in AvaDent's free patient referral program AvaLeads? *

YES

NO

Please send me my login for AvaDent's FREE patient education software? *

YES

NO