Name* First Last Email* Phone*Practice Name* Specialty* Average Monthly Collections*(Select One)$10,000 or less$10,001 - $19,999$20,000 - $29,999$30,000 - $39,999$40,000 - $49,999$50,000 - $59,999$60,000 - $69,999$70,000 - $79,999$80,000 - $89,999$90,000 - $99,999$100,000 or moreAverage # Procedures Per Month*(Select One)500 or Less501 - 9991,000 - 1,4991,500 - 1,9992,000 - 2,4992,500 - 2,9993,000 - 3,4993,500 - 3,9994,000 - 4,4994,500 - 4,9995,000 - 5,4995,500 - 5,9996,000 - 6,4996,500 - 6,9997,000 - 7,4997,500 - 7,9998,000 - 8,4998,500 - 8,9999,000 - 9,4999,500 - 9,99910,000 or moreCAPTCHA Share this:FacebookTwitterLinkedIn