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BLEC Co-Management
Lead Provider Name
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Email Address
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Phone Number
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Clinic Name & Location
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Years in Practice
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Fax Number
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What are you current diagnostic capabilities?
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On a scale of 0-10, how proactive is your practice in educating patients on premium/lifestyle lens options prior to surgical referral?
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On a scale of 0-10, how proactive is your practice in educating patients on premium/lifestyle lens options prior to surgical referral?
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10
What implies "Success" to you in a co-managed relationship?
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What are some challenges you wish to wish to address from current/previous co-management relationship(s)?
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Submit