Testing new form

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Full Name

Phone Number

Email

Country

City

District

Full address

University

Major

Graduation year

Are you a Dentist?

Yes No

Do you have partners?

Yes No

Partner Full Name

University

Major

Partner Title

Do you have your own laboratory?

Yes No

Is the laboratory operating digitally or/and conventionally?

Digitally Conventionally Both

Do you want to change your current clinic or are you considering a new clinic

New Clinic Change My Clinic

Clinic Name

Is your clinic on ground floor?

Yes No

How many floors does your clinic have?

How long has been your clinic operating?

How many square meters is the clinic?

How many units are there?

Is there an extra unit capacity?

Yes No

What is the total number of employees?

How many dentists?

Which of these licenses do you have?

Examination Policlinic Oral and dental health center None

Pictures & Videos

Photos of the clinic that need to be taken

Front side of the clinic
Entrance/Reception
Patient waiting room
Patient rooms
Dental units
Sterilization room
X-Ray room
Laboratory(If any)

Upload pictures (required)

A video of the entire clinic, starting from the exterior, continuing with the entrance / counter, and finally shooting all the rooms where the dental units are located. (Maximum 2 minutes)(Optional)

Video of the Clinic (optional)

Where do you want establish a new clinic?

Country

Province/State

District

How many units you want?

Description

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