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Practice name
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Website URL
First name
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Last name
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Email address
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Phone Number
City
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Province
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Confidentiality
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University
Graduation year
Number of Dentists
1
2
3
4
5+
Number of Active Patients
0-1000
1001-2000
2001-3000
3001-4000
4001-5000
5000+
What is your motivation for partnership?
Transition/Transition Planning
Reduced Administrative Burden
Growth
Other (Please explain below)
What benefits or support are you looking for?
More Time for Patient Care
Work-Life Balance
Reduced Overhead
Recruitment Support
Marketing Services
Training and Development
Operations Support
HR Support
Other (Please explain below)
Any additional information you would like to provide?
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