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* 1. Contact Name:

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* 2. Contact Title

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* 3. Contact Phone Number:

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* 4. Contact Email Address:

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* 5. DSO Legal Name and/or DBA:

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* 6. Website:

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* 7. Total Number of Locations?

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* 8. Total Number of States group has Locations?

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* 9. Total Number of Locations doing Orthodontics?

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* 10. Number of Orthodontists (Specialists) doing Ortho?

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* 11. Number of General Dentists (GP's) doing Ortho?

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* 12. How many total annual New Patient Ortho Starts for Braces in PY?

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* 13. How many total annual New Patient Ortho Starts for Aligners in PY?

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* 14. What is your annual goal for New Patient Ortho Starts for Braces this year?

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* 15. What is your annual goal for New Patient Ortho Starts for Aligners this year?

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* 16. DSO Primary Contact(s):

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* 17. DSO Purchasing Mgr(s):

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* 18. DSO KOL Doctor(s):

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* 19. Primary Bracket/Band/Wire Ortho Supplier(s):

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* 20. Current Price Per Metal Bracket?

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* 21. Current Price per Clear Bracket?

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* 22. Current Cost Per Patient (CPP) for Ortho Supplies?

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* 23. Do all doctors in this DSO currently use same line of brackets/bands?

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* 24. Primary Clear Aligner Supplier(s):

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* 25. Current Aligner Lab Fee for FULL Comprehensive Treatment:

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* 26. Average Patient Down Payment Required for Aligners:

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* 27. Is DSO required to pay full aligner lab fee upfront?

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* 28. Is DSO interested in our SLX Clear Aligner SCALE plan that helps with cash flow, flexibility, and case acceptance by removing the upfront strain of large aligner lab fee?

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* 29. Does DSO use HenrySchein.com for general purchases?

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* 30. Is DSO interested in our new One Schein ordering system that would allow all HSO products to be ordered via their current Schein system with consolidated invoices for general and ortho?

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* 31. Does DSO have Central Purchasing System (PO) with Purchasing Mgr for review and approval of orders?

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* 32. Does DSO have any reporting requirements on spend?

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* 33. Does DSO actively track Ortho supply budgets per location?

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* 34. Does DSO want to provide clinical CE support for Ortho doctors and/or staff?

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* 35. Does DSO want to provide operational CE support for Ortho TC's and management on case acceptance and KPI's to drive higher conversion rates and top line growth?

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* 36. Does DSO want support with Ortho assistant training using our Trapezio partner program?

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* 37. Does DSO want doctor recruiting support by using our exclusive Ortho Job Match program with orthodontic residents across the country?

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* 38. Does DSO have SOP's in place for Ortho instrument care, inventory mgmt, class II/III correction and/or DENOVO orders?

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* 39. Is growing Ortho business within the DSO a focus?

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* 40. Is DSO interested in our new Sagittal First workflow solution for orthodontics to help reduce treatment times, increase case acceptance, and enable same-day-starts across all locations?

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* 41. Is a Growth Rebate program for Ortho important?

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* 42. Is a Price Lock Protection agreement (PVA) important?

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* 43. Other Notes, Needs, and Key Information:

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