E-School LIVE Patient Application/ Referral Form by soniachopra | Jun 24, 2022 | 0 comments Welcome to your E-School LIVE Patient Application/Referral Form Thank you for your interest in being a patient for a future E-School LIVE session! Please complete the application below so that we can determine how best to serve you. What is E-School LIVE? E-School LIVE is a training program for general dentists taught by Dr. Chopra. Each root canal is performed by a general dentist in the program under Dr. Chopra's direct supervision. Please keep in mind this program is for Root Canal Therapy only and there are exclusions that may prevent you from being accepted in the program. Eg, no second molars (first molar to first molar only), no retreatments, no teeth with existing crowns, no small children, no pregnant patients. If your application is accepted, we will appoint you to see if you are a candidate for the program. Not everyone who fills out an application is a candidate. First & Last Name Email Phone Number (optional) What E-School LIVE dates work for you? Add description here! November 2022 February 2023 What is your location? All E-School LIVE sessions are located in Charlotte, North Carolina. What dental work do you need performed? The endodontic focus is to treat conditions affecting the tooth pulp (the center of your teeth) and the tissue that surrounds the roots of your teeth. Crowns & Fillings Braces Root Canal Extractions Who is your general dentist? What are their contact details? Please upload your referral slip (a photo is fine) Please upload an X-Ray File Time is Up! Time's up Submit a Comment Cancel replyYour email address will not be published. Required fields are marked *Comment * Name * Email * Website