Thank you for your interest in E-School LIVE!

I really love this program, and I believe in the power of in-person, hands-on training. Please fill out the following questions so I know if you're a good fit for the program at this time. (If you aren't now, you might be later!)

 

Full Name
Practice Name
Email
Facebook Profile Link (optional)
Instagram Profile Handle (optional)
LinkedIn Profile Link (optional)
Have you enrolled in E-School?

If you have enrolled in E-School with Coaching, have you completed the curriculum?

Are you licensed to practice in the United States of America?

Where are you licensed to practice? (State/Province, and/or Country)

Malpractice Insurance: Participants in E-School LIVE must provide proof of valid malpractice insurance coverage that covers this exposure in the United States upon registration for the program. NOTE: Dental residency insurance is insufficient to qualify for E-School LIVE, since it typically only offers coverage for treatments offered through the program or hospital where you are a resident. IMPORTANT: You must be able to send proof of insurance to my team IMMEDIATELY after you register. I STRONGLY recommend that you inform your malpractice insurance about this exposure in the United States BEFORE you apply, as I WILL NOT ISSUE A REFUND IF YOU ARE UNABLE TO ARRANGE COVERAGE AFTER THE FACT. This is particularly important for Canadian and international attendees.

By completing and submitting this application form you confirm that you have read and agree to the following:
I understand that if I proceed to register for E-School LIVE and I do not have valid malpractice insurance, I will not be able to participate in the program. I also understand that the registration fee is NON-REFUNDABLE, and if I register and am disqualified from participating for any reason I will forfeit my payment.

Do you understand that you need to have malpractice insurance, if you're selected to attend?

Dental Assistant: Participants in E-School LIVE must bring their own trained dental assistant to the training. Ideally your assistant works with you in your practice, so they can benefit from the training and help you implement when you return to your own practice. The assistant you bring to the LIVE training must be able to suction and take an X-ray. You will be treating live patients, and WE CANNOT ALLOW UNTRAINED ASSISTANTS to participate in treating these patients because this will result in a stressful experience with you—there will be tears. (Please Note: You may not bring a friend or family member who is not a trained dental assistant.)

By completing and submitting this application form you confirm that you have read and agree to the following:

I understand that if I proceed to register for E-School LIVE and I cannot arrange for an assistant to join me for the LIVE training, I may not be able to participate in the program. I also understand that the registration fee is NON-REFUNDABLE, and if I register and am disqualified from participating for any reason I will forfeit my payment.

Do you understand that you need to bring your own trained dental assistant with you, if you're selected to attend?

Why are you interested in E-School LIVE? Click any that apply.