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Dentistsurvey

Dentist Survey

Please answer the questions below, and be eligible to receive a free copy of Dr. Mike Kesner's book, "Multi-Dollar Dental Practice," a $24.95 value.

 

* Name:
* Practice Name:
* Phone:
* Email:

1.) How does your production this year compare to last year?

* Option:
Up
Down
Same

2.) What are your office expenses this year compared to last year?

* Option:
Up
Down
Same

3.) What are the biggest challenges you face at your practice? (Please check all that apply)

* Options:
Marketing/Getting New Clients
Personnel Issues
Costs & Overhead
Working too hard & too long
Growing Revenue
Address (Please provide mailing address for your practice in case you're chosen to receive a free gift from Quantum Leap Success.)
Street Address:
Address Line 2:
City:
State/Province/Region:
Country:

Type the letters you see in the image below.

Enter Verification Characters:

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* required information

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