Attending Doctor First Name
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Attending Doctor Last Name
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Attending Doctor Cell Phone # (For Course Communication)
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Doctor NPI #
Dr. Email (For Course Communication)
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Practice Name (School Name if resident)
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Practice Location
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Dietary Restrictions
What topics are you hoping to discuss during the course?
What is the most important thing you are looking to learn from the course?
Other than the planned clinical content, what else are you hoping to learn at the course? (Marketing, Lab, TC, etc.)
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Rocket Ortho
