E-School Live ApplicationDecember 12, 2023What’s Your Endodontic Know-How?December 12, 2023 Published by bossmarketing on December 12, 2023 Welcome to your E-School LIVE Patient Application/Referral Form First & Last Name Email Phone Number E-School LIVE takes place on March 2nd and March 3rd, 2024 Are you available on March 2nd AND March 3rd, 2024? We cannot guarantee which day or what time we can fit you in for an appointment, so you MUST be flexible and available at any time on both days in order to be eligible. Yes, I am available and flexible on BOTH Saturday and Sunday I am only available on ONE of the days I am not available on either of the listed days What is your location? All E-School LIVE sessions are located in Charlotte, North Carolina. Patients are welcome from all over, but you must be willing to travel and pay for your own accommodations in Charlotte. What dental work do you need performed? The endodontic focus is to treat conditions affecting the tooth pulp (the center of your teeth) and the tissue that surrounds the roots of your teeth. Crowns & Fillings Braces Root Canal Extractions Cleanings Who is your general dentist? What are their contact details? Please upload your referral slip (a photo is fine) Please upload an X-Ray File Not everyone who fills out this application is a candidate for treatment at E-School LIVE. Each application will be reviewed by a member of Dr. Chopra’s staff, and you will be reached out to if you have been selected for treatment. By checking the box below you acknowledge this statement. I understand that submitting this application does not guarantee I will be eligible for treatment at E-School LIVE. I do not acknowledge the above statement. Time's up Share bossmarketing Leave a ReplyYour email address will not be published. Required fields are marked *Comment * Name Email Website Save my name, email, and website in this browser for the next time I comment.