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	*Doctor's First Name: *Doctor's Last Name: *Type of Doctor: GP (w/ aligner experience) GP (no aligner experience) Orthodontist Resident Other Practice: Contact's Name: Address: City: State: Zip: *Phone: *Email: *How did you hear about us? Referral (Please provide name under comments) PNDC tradeshow AGD tradeshow Direct Mailer (promo code ORTHO1) Direct Mailer (promo code 80%) Direct Mailer (promo code MORE2) Direct Mailer #59 December Direct Mailer #59 January Direct Mailer #54 Direct Mailer #12 Direct Mailer "More" Comparison Journal of the American Orthodontic Society article Journal of the American Orthodontic Society ad Dental convention/tradeshow Internet research Email - Top 3 Reasons Dentaltown website article Dentaltown magazine article Dentaltown website ad Dentaltown message boards Email "Top 2 Reasons Dentists Switch to ClearCorrect" Dental Economics ad Dental Economics online article Dentistry Today ad Dental Products Report magazine ad Dental Products Report web ad Dental Products Report email Dental Product Shopper ad Dental Product Shopper article Drbicuspid.com web ad Drbicuspid.com Letter from the Editor Inside Dentistry ad Press release PowerPR email Other (please explain in comments) Any Comments (specific questions, doctor who referred you):

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