HSORESIDENT.COM ONLINE PROFILE FORM

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* 1. Resident/Doctor Name

First Name

Last Name

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* 2. Best Email Address

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* 3. Best Cell Phone/Text

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* 4. Gender (optional)

Male

Female

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* 5. Ortho Program Attended

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* 6. Graduation Month

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* 7. Graduation Year

Top 2 Rank of Locations Desired to Practice

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* 8. First Choice - State

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* 9. First Choice - City (optional)

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* 10. Second Choice - State (optional)

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* 11. Second Choice - City (optional)

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* 12. Interested in our exclusive Job Match program to search for orthodontic opportunities with top DSO's across the country?

Yes

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* 13. Interested in receiving information on our new HSO Grad Package deals for startup orders and financial assistance after graduation?

Yes

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* 14. Preference on Bracket Slot

.018

.022

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* 15. Preference on Bracket RX

Roth

MBT

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* 16. Preference on treatment type

I prefer Conventional Brackets

I prefer Self-Ligating Brackets

I prefer Clear Aligners

No preference

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* 17. Preference on Class II Correction

Carriere Motion

3M Forsus

Herbst

No preference