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About us
Hype 3D MemoryTech Aligner®
Treatment Process
Gallery
FAQ
Contact us
About us
Hype 3D MemoryTech Aligner®
Treatment Process
Gallery
FAQ
Contact us
Client Portal
New Customer Intake Form
Practice Name
Primary Address
Phone
Fax
Primary Admin Contact
Email
Phone
Primary Billing Contact
Email
Phone
Total Office Locations
Total Orthodontists
Total Dentists
Centralized Billing
Yes
No
Do doctors practice at multiple locations
Yes
No
What Aligner Companies have you previously used
Average # of aligner cases per month
Person responsible for Portal Setup
Best day(s) of week for portal training
Best time to train
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